How Evidence-Based Health Policy Can Address the Opioid Epidemic
Emergency departments are often the only interaction with the health care system that many patients with opioid use disorder (OUD) have, and are a vital location to focus efforts on initiating medications for OUD (MOUD). A new Health Affairs study evaluates CA Bridge, a program that supports hospitals in implementing low-threshold ED buprenorphine, bundled with patient navigation and harm reduction techniques.
The program focuses on access to low-barrier treatment and connection to community resources, while developing treatment algorithms, screening protocols, and creating "Bridge Clinics" (addiction clinics). Following its initial success, the California Department of Healthcare Services allocated $40 million to expand it to more than 200 hospitals. Hospitals could apply for funding to hire a patient navigator, a "clinical champion," develop naloxone distribution programs, and implement the CA Bridge protocols. The authors tracked CA Bridge implementation from July 2022 to December 2023. They found that ED-based addiction care can be implemented efficiently at scale.
Across CA Bridge hospitals, there were 165,671 patient-navigator encounters and 44,996 buprenorphine prescriptions. Public hospitals outperformed private hospitals: navigator engagement and buprenorphine treatment rates were more than 50% higher in public facilities, suggesting that safety-net systems may be especially well-positioned to deliver low-barrier care when supported both administratively and financially. In 2022, California emergency clinicians wrote 6,382 buprenorphine prescriptions; notably, roughly 22% were new prescribers. Among patients who received ED buprenorphine, 36% had a subsequent prescription within 40 days, indicating early continuity for a meaningful share of patients.
CA Bridge is successful because it consolidates information in a single location, enabling easy access for health care teams and hospital administrators to facilitate rapid identification of solutions to common obstacles.
- Other state and federal policymakers should allocate funding for pilot programs to assess treatment strategies and identify that may work best within their jurisdiction.
- Legislation should reduce barriers to establishing addiction clinics to ensure continuity of care for MOUD initiation.
- Health departments should collaborate with providers to develop treatment protocols that are most effective, enabling any physician to initiate MOUD easily, effectively, and repeatedly.
- The CA Bridge experience also argues for sustained state funding beyond pilot grants to maintain the program.
CA Bridge demonstrates that, with targeted funding, technical assistance, and patient navigation, ED-initiated buprenorphine can be implemented at scale. For emergency medicine and policymakers, the next step isn't proving the concept; it's sustaining and spreading the model with financing and equity-tied accountability so that every ED visit is a real doorway to treatment.
Abstract
Samuels EA, Rosen AD, Abusaa S, et al. Increasing emergency department patient navigation and buprenorphine use: a model for low-barrier treatment. 2025;44(9):1138-1147.
Background
Emergency departments (EDs) in the U.S. treat large numbers of people with opioid use disorder (OUD), but most health systems do not equip EDs to provide OUD care. CA Bridge has supported the implementation of low-threshold, ED-initiated medications for OUD bundled with harm reduction and patient navigation in more than 80% of California EDs.
Review
Using grant reporting and California controlled substances prescribing data, we assessed CA Bridge implementation from July 2022 through December 2023, as well as 2022 California statewide ED buprenorphine prescribing.
Results
There were 165,671 patient navigator encounters and 44,996 instances of buprenorphine treatment at CA Bridge hospitals; patient navigator and buprenorphine treatment rates at public hospitals were more than 50% higher than at private hospitals. In 2022, across the entire state, 1,737 California emergency clinicians wrote 6,382 buprenorphine prescriptions; 36% of the people who were given those prescriptions received a subsequent buprenorphine prescription within 40 days.
Conclusion
Our findings suggest that EDs can reach large numbers of people with OUD, and buprenorphine uptake is high.
EMRA + PolicyRx Health Policy Journal Club: A collaboration between Policy Prescriptions and EMRA
As emergency physicians, we care for all members of society, and as such have a unique vantage point on the state of health care. What we find frustrating in our EDs - such as inadequate social services, the dearth of primary care physicians, and the lack of mental health services - are universal problems. As EM residents and fellows, we learn the management of myocardial infarctions and traumas, and how to intubate, but we are not taught how health policy affects all aspects of our experience in the ED. Furthermore, given our unique position in the health care system, we have an incredible opportunity to advocate for our patients, for society, and for physicians. Yet, with so many competing interests vying for our conference education time, advocacy is often not included in the curricula. This is the gap this initiative aims to fill. Each month, you will see a review of a new health policy article and how it is applicable to emergency physicians.