CA Bridge is disrupting the addiction treatment landscape by ensuring that every hospital in California provides 24/7 access to evidence-based care, treating substance use disorder (SUD) like any other life-threatening condition. CA Bridge is working with hospital emergency departments (EDs) to provide immediate access to medication for addiction treatment (MAT) to anyone seeking help. CA Bridge is a program of the Public Health Institute.
Low Barrier MAT in the ED
Hospital EDs are an underutilized resource in the fight against the overdose crisis, as no other setting can provide 24/7/365 access to care combined with the high-level medical wrap-around services available in an ED. Key elements of the CA Bridge model include:
- Low-barrier, immediate access to MAT
- Navigation to ongoing care and community
- A culture of harm reduction
CA Bridge has conducted rigorous research on its program. Studies have shown that it is feasible to implement low-barrier MAT in all types of EDs, that it successfully reaches low-income patients, and that low-barrier MAT is effective even with the increasing presence of fentanyl in the drug supply.
Navigators are a critical component of the program. Guided by the principles of harm reduction, they work with hospital staff to change organizational culture to reduce stigma and put patients’ goals first. A study at Highland Hospital in Oakland demonstrated that patients seen by a navigator were three times more likely to be in follow-up treatment 30 days after their ED visit.
CA Bridge launched at 52 hospitals in 2018 with a grant from the MAT Expansion Project. In 2020, a state appropriation of $20 million extended funding to 206 hospitals as part of the Behavioral Health Pilot Project. In the spring of 2022, a new appropriation of $40 million launched the CalBridge Behavioral Health Navigator Program which has supported 282 hospital EDs to provide MAT and behavioral health navigation to 9,500 people each month. Funding was awarded on a rolling basis between July 2022 and February 2023 with hospitals having 12-15 months for implementation.
Innovations for Better Care
Treating opioid use disorder with MAT in the ED is the foundation of CA Bridge. However, the negative consequences associated with substance use are deep and complex. To further expand opportunities to improve care for people who use drugs, CA Bridge is pursuing innovation at multiple levels:
- Low-Barrier MAT Clinics. Recognizing the challenge of transitioning patients from the ED to ongoing MAT, a growing number of CA Bridge hospitals have developed their own low-barrier MAT clinics. Sometimes known as “Bridge Clinics,” these facilities have proven highly successful in increasing follow-up rates.
- Harm Reduction in the ED—CA Bridge is introducing ED staff to harm reduction practices, such as distributing naloxone for overdose reversal, safe injection supplies, fentanyl test strips, and patient education on using drugs more safely.
- Youth—CA Bridge is making treatment in the ED more accessible to young patients to prevent youth from developing devastating use disorders.
- Mental Health—Many patients with SUDs also suffer from mental health conditions. Navigators will connect patients with community mental health providers to better leverage ED resources to provide integrated care to patients.
- Racial Equity—CA Bridge is committed to addressing the structural racism, which has led to drug policy and healthcare practices that create harmful disparities associated with drug use for people of color. CA Bridge supports decriminalizing drug use, develops equity and inclusion tools and trainings, and commits to increasing the representation of communities of color on the CA Bridge team.
- Alcohol and Stimulants—Alcohol accounts for more non-fatal ED visits than all other drugs combined, and CA Bridge is working with navigators and clinicians to make treatment for alcohol use disorder available in the ED. CA Bridge also offers training on managing stimulant use and helping patients use more safely.
CA Bridge has a searchable library of resources on many aspects of SUD care and navigation. Anyone is welcome to participate in the program’s regular trainings for clinicians, navigators, and program staff. Reach out to firstname.lastname@example.org with any questions. Other resources include:
- Map of Hospitals Using the CA Bridge Model
- Blueprint for Hospital Opioid Use Disorder Treatment
- Substance Use Navigation Toolkit
This project receives funding from the State Opioid Response (SOR) grant through the Substance Abuse and Mental Health Services Administration (SAMHSA).