There were more than 7,000 emergency room visits and a record number of opioid overdose deaths — nearly 450 — in 2017, according to the County of San Diego. To combat this epidemic, UC San Diego Health is among 31 health facilities selected from across the state to participate in the California Bridge Program, an accelerated, 18-month training program for health care providers to enhance access to around-the-clock treatment for patients with opioid use disorder.
Emergency Department at UC San Diego Medical Center
The program, facilitated by the Public Health Institute’s ED-Bridge program, provides chosen sites with funding, training and technical assistance to improve and increase access to treatment of acute symptoms, initiation of long-term mediation and referrals to outpatient clinics.
There are three types of sites in the California Bridge program: Star Sites, centers of excellence for initiating treatment of substance use disorders from anywhere in the hospital; Rural Bridge Sites, where treatment will begin primarily in the emergency department with the support of substance use navigators; and Bridge Clinics, “low-threshold" follow-up clinics that patients can visit after starting treatment in a hospital setting. UC San Diego Health was selected as a Star Site, one of 16 in the state, and received $260,000 from the program.
“Historically, we could only treat the symptoms of withdrawal or overdose when patients with opioid use disorder presented. We did not have the resources or medications necessary to prevent patients from going out, using again and coming back to the emergency department with an overdose,” said Daniel Lasoff, MD, emergency physician at UC San Diego Health. “This grant allows for additional staff and education to recognize substance abuse as a treatable disease and give rapid, evidence-based treatment that enables patients to enter and remain in treatment.”
The Bridge model treats emergency rooms and acute care hospitals as the frontline for initiating treatment. The best outcomes occur when patients start and are retained in long-term recovery treatment with medications. When patients in opioid withdrawal come seeking medical care, including for reasons not related to opioid use, they will be offered medication, such as buprenorphine, to ease severe symptoms of withdrawal and begin maintenance treatment. They will then be connected with outpatient treatment at UC San Diego Health or in the community.
UC San Diego Health Emergency Department in La Jolla
“The medication we can now give patients treats opioid use disorder. It is a game-changer because it helps prevent the long-term craving patients have that triggers relapse while also treating the symptoms of withdrawal,” said Lasoff. “Once the medication takes effect and the patient’s withdrawal symptoms and cravings are managed, a counselor will work with the patient to facilitate further treatment in an outpatient setting.”
A referral to an addiction treatment program has been the primary option that hospitals have generally been able to offer patients identified as needing treatment for opioid use disorder. Studies have shown that initiating treatment and providing medication designed for addiction treatment are more likely to result in patients remaining in care and having better long-term outcomes than those who are given referral information alone.
“By suppressing withdrawal long enough to create a bridge for patients to enter and remain in treatment, physicians can save lives,” said Andrew Herring, MD, director of emergency department services for the Bridge program. “We know this model works, and now we are bringing it to hospitals and emergency rooms all across the state that are anxious for real solutions to address the enormous pain and suffering they see every day caused by the opioid epidemic.”
The Addiction Recovery and Treatment Program at UC San Diego Health provides patients with outpatient behavioral treatment for substance use, such as cannabis, alcohol and opioids.
“There are many barriers preventing patients with substance use disorders from following through on making the connection to substance use treatment programs, but starting them on medication that has such a big impact on their symptoms in such a short time dramatically improves their likelihood of continuing care with this life-saving medication. Buprenorphine not only helps prevent relapse to opioid use, but also protects against opioid overdose,” said Carla Marienfeld, MD, psychiatrist and director of the Addiction Recovery and Treatment Program at UC San Diego Health.
“Being part of the Bridge program means there will be a continuum of care, from starting medications to directly linking patients to follow up care so they get the comprehensive treatment they desperately need.”
Full list of California Bridge Program sites: www.phi.org/news-events/1564/california-bridge-program-selects-31-health-facilities-to-expand-mat-for-opioid-use-disorder