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Bridge Clinics: A Scalable Solution for SUD

Authored by Ishan Shah


Substance use disorder (SUD) is a neurophysiological disease characterized by a chronic urge to use a drug that produces a reward, despite its negative consequences. Due to its variability, chronic effects, the potential for relapse, and widespread state, impacting 46.3 million people, it can be a challenging disease to address [1]. 107,081 deaths were reported in 2022 due to drug overdoses of which over two-thirds were due to synthetic opioids, primarily fentanyl [2]. There is no question that the overdose epidemic is a major public health concern in our nation. Yet, the infrastructure of the addiction medicine system is not built to support the many people suffering and dying from this disease. There are not even enough trained physicians, as there are around only 3,000 physicians trained in addiction medicine or addiction psychiatry [3]. 


Despite our system’s shortcomings,  there are fortunately evidence-based treatments offered for SUD like the administration of buprenorphine and methadone through agonist substitution treatment. This treatment method involves prescribing patients these opioids which will effectively out-compete other opiates like heroin and fentanyl. It has been shown to reduce cravings, prevent withdrawal, and regulate physiological functions [4]. Currently, the process of accessing buprenorphine and methadone for patients is rather challenging due to the stigma around replacing one substance with another. To combat the barriers to treatment for substance use disorder, bridge clinics, which offer medication-assisted treatment and other resources for addiction treatment, were designed [5]. 


But do bridge clinics really work to improve patient outcomes? A study by D’Onofrio et al. (2015) showed a significant increase in engagement in addiction treatment for patients whose care was initiated in emergency departments [6]. Furthermore, the emergency department model of bridge clinics displayed a higher likelihood of being linked to long-term care in the study performed by Serdarevic et al. (2023) [7]. Lastly, a study done by Sullivan et al. (2021) demonstrated that buprenorphine bridge clinics decreased future patient emergency department visits [8]. All in all, this is extremely promising evidence for some model of bridge clinic to succeed in a large-scale intervention for SUD. 


CA Bridge is a program from California working to implement opioid use disorder care into emergency departments. Striving to reach all California hospitals with 24/7 opioid use disorder care by 2025 and aiming to extend into other states and develop a national standard of care for emergency departments. CA Bridge programs utilize a special system of patient navigation. Hiring patient navigators is an economical and practical solution to guide patients to the correct care and prevent patients from returning to the emergency department [9]. Lastly, CA Bridge has placed a huge emphasis on combating stigma and creating a low-threshold, accepting place for treatment. 


What is really impressive is that expansion of these bridge clinics has happened very fast. Starting in June 2018 at just four hospitals, CA Bridge has grown into over 200 hospitals today [10]. The question is whether bridge clinics will be the solution to the over one million deaths that are estimated to take place from overdoses in the next 10 years. It is possible that we see this integration of addiction care in emergency departments nationally very soon. But, there are also models of bridge clinics that exist outside of the emergency department, which are likely more expensive and time consuming to start up, but also have their own advantages. The American Society of Addiction Medicine has tested the feasibility of a telemedicine bridge clinic, which proved to be promising to introduce patients into addiction treatment [11]. It will be interesting to observe what models expand and succeed to battle addiction and overdoses in our nation, despite the many barriers associated with implementing each of them. 


Bridge clinics serve to be a promising solution to a huge issue that is pressing our nation today and is only growing. Will people be able to receive medication-assisted therapy for SUD online through telemedicine bridge clinics or in-person in the emergency department? The answer is hopefully both. As bridge clinics continue to pop up around our nation and the addiction medicine network is built, we wonder how this will impact the delivery of treatment for SUDs and how exactly addiction medicine will look in the near future. With various exciting models, we hope bridge clinics in any or all forms will be the scalable solution to the SUD problem. 


References

  1. Substance Abuse and Mental Health Services Administration (2023, January 4). SAMHSA Announces National Survey on Drug Use and Health (NSDUH) Results Detailing Mental Illness and Substance Use Levels in 2021. US Department of Health and Human Services.

  1. Beckwith, R. T. (2023, August 31). ICYMI: Biden-⁠Harris Administration Announces $450M to Support President Biden’s Unity Agenda Efforts to Beat the Overdose Epidemic & Save Lives. The White House. https://www.whitehouse.gov/ondcp/briefing-room/2023/09/01/icymi-biden-%E2%81%A0harris-administration-announces-450m-to-support-president-bidens-unity-agenda-efforts-to-beat-the-overdose-epidemic-save-lives/#:~:text=In%202022%2C%20more%20than%20two,for%20Disease%20Control%20and%20Prevention.

  2. Scutti S. (2019, December 18) 21 million Americans suffer from addiction. Just 3,000 physicians are especially trained to treat them. Association of American Medical Colleges. https://www.aamc.org/news/21-million-americans-suffer-addiction-just-3000-physicians-are-specially-trained-treat-them

  3. Substance Abuse and Mental Health Services Administration. (2023, September 28). Medications, Counseling, and Related Conditions. SAMHSA. 

  1. FDA. (2023, May 23). Information about Medication-Assisted Treatment (MAT). U.S. Food & Drug Administration. 

  1. D'Onofrio G, O'Connor PG, et al. Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial. JAMA, 2015;313(16):1636-1644. doi: https://doi.org/10.1001/jama.2015.3474. 

  2. Serdarevic M, Cvitanovich M, et al. Emergency Department Bridge Model and Health Services Use Among Patients With Opioid Use Disorder. Annals of Emergency Medicine, 2023;82(6):694-704. doi:https://doi.org/10.1016/j.annemergmed.2023.06.014. 

  3. Sullivan RW, Szczesniak LM, and Wojcik SM. Bridge clinic buprenorphine program decreases emergency department visits. Journal of Substance Abuse Treatment, 2021;130.

  1. Orme S, Zarkin GA, et al. Cost and Cost Savings of Navigation Services to Avoid Rehospitalization for a Comorbid Substance Use Disorder Population. Med Care. 2022;60(8):631-635. doi:10.1097/MLR.0000000000001743. 

  2. Integrating Bridge Clinics into Emergency Departments to Facilitate Access to Opioid Use Disorder Care. The Better Care Playbook. The Playbook. 

  1. Lynch MJ, Houck P, et al. Use of a Telemedicine Bridge Clinic to Engage Patients in Opioid Use Disorder Treatment. J Addict Med. 2022;16(5):584-587. Doi: https://doi.org/10.1097/ADM.0000000000000967. 

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