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
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. Results from a study of CA Bridge’s first cohort (summarized in Health Affairs) demonstrate the feasibility of adopting low-barrier MAT in all EDs.
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 to enable all 330 hospital EDs to provide 24/7, high-quality care to people with SUD. This program is accepting applications on a rolling basis through December 15th, 2022.
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 leading multiple groundbreaking initiatives:
- 911—CA Bridge is working with Contra Costa and Alameda counties to help them become some of the first municipalities in the country to train paramedics in initiating buprenorphine treatment from the ambulance.
- Meth, Alcohol, and Fentanyl—In California, methamphetamine, cocaine, and other stimulants are as widely used as opioids. Alcohol accounts for more non-fatal ED visits than all other drugs combined, and fentanyl is dramatically increasing overdose deaths. CA Bridge is working with hospitals to pilot effective and efficient ED interventions for these drugs.
- 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.
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 email@example.com with any questions. Other resources include:
- Map of Hospitals Using the CA Bridge Model
- Blueprint for Hospital Opioid Use Disorder Treatment
This project receives funding from the State Opioid Response (SOR) grant through the Substance Abuse and Mental Health Services Administration (SAMHSA).