Developed by a team of experienced emergency medicine clinicians, our quick-start treatment protocols offer guidance on the use of buprenorphine for ED and hospitalized patients.
CA Bridge saves lives by enabling people who use drugs to get medication for addiction treatment (MAT) in Emergency Departments throughout California.
Our Model
24/7 open door access to evidence-based addiction treatment
Treatment
Immediate access to low-barrier MAT
Culture
A culture of harm reduction that offers treatment without stigma
Connection
Connection to continued care in the community through trained navigators
Our Impact
276 California hospitals rapidly adopted the CA Bridge model
With funding from State Opioid Response, the Behavioral Health Pilot Project, and the CalBridge Behavioral Health Navigator Program, California has led the largest expansion of ED MAT in the country.
Our EDs are prepared to offer low-barrier access to addiction treatment to all patients
substance use
disorders
or administered
MAT
with a follow-up
appointment
EDs reach especially vulnerable patients
- 33% of patients are people of color
- 1 in 3 patients did not have stable housing
- 77% were uninsured or covered by Medi-Cal
- 70% had co-occurring mental health conditions
- One in five patients served came to the ED for a health issue unrelated to their substance use. Even though they were not seeking care for addiction, over half of them accepted treatment when it was offered.
Data reported in Kalmin MM, Goodman-Meza D, Anderson E, Abid A, Speener M, Snyder H, Campbell A, Moulin A, Shoptaw S, Herring AA. Voting with their feet: Social factors linked with treatment for opioid use disorder using same-day buprenorphine delivered in California hospitals. Drug Alcohol Depend. 2021 May 1.
We’ve demonstrated that people want help with addiction
It is a myth that people struggling with addiction do not want treatment. Our data shows that patients accept addiction treatment when we make low-barrier treatment accessible.
- 40% of patients offered treatment in the ED accepted it. This number rose to 85% when patients saw a substance use navigator.
- Patients who received MAT in the ED were twice as likely to be in treatment 30 days later than those who did not.
From the ED, patients are connected to ongoing care
- On average, 40% of patients who start treatment in the ED are connected to ongoing follow-up care.
- When a patient meets with a navigator, they are three times more likely to be engaged in treatment at 30 days.
We achieved these results by training 2,086 medical providers, navigators, and hospital staff in a movement for universal access to addiction treatment.
The Opportunity: A New Approach to Substance Use
5.3 million Californians have a substance use disorder, but only 10% receive treatment. With 1.1 million people with a diagnosed substance use disorder coming to California EDs each year, there is tremendous potential to reach more people through expansion of ED services. Overdose deaths are at unprecedented levels — we have a moral imperative to do more.
Various factors can lead to addiction such as life challenges, trauma, or isolation as well as genetics, culture and environment. Treating addiction and supporting recovery requires taking care of the whole person, as well as addressing social and structural factors. It may never be possible to say why a given person might develop a substance use disorder. Like many other diseases, it could happen to any of us.
Our society has relied too heavily on incarceration.
- Over the last 40 years, the U.S. incarceration rate tripled to the highest of any country in the world and five times the global average.
- Much of this increase was driven by the war on drugs, as arrests for drug possession tripled.
- These laws were created to reinforce and ultimately increase racial disparities. Even though White Americans and people of color use drugs at approximately the same rate, arrest rates for drug possession are at least more than twice as high for Black people than White people.
Addiction is a treatable, chronic disease—not a moral failing.
While initial use of a drug may be voluntary, extended use can change brain chemistry, causing the brain to become dependent on drugs, without which, a person will go into unbearable withdrawal. Substance use disorder is no more a voluntary choice than many other chronic illnesses, like diabetes or heart disease, that are brought on by a combination of human behavior and biology. Using drugs is no longer about getting high but restoring a feeling of normality—a need so great that it can replace the need for food and shelter.
Treatment works, but too many people do not receive it.
Despite evidence that medication for addiction treatment (MAT) is an effective and overall cost-saving method for treating opioid use disorder, 60-80% of people who use opioids do not have access to these medications.
- Medication for addiction treatment (MAT), such as buprenorphine, is proven to help patients dealing with substance use disorder. With treatment, the brain’s chemistry can be rebalanced, and the physical symptoms of withdrawal can be managed.
- MAT is effective at lowering illicit opioid usage, reducing hospital emergency room visits, and improving adherence to drug addiction treatment programs.
Discrimination and stigma create missed opportunities for treatment.
- Across the medical profession and most sectors of society, people with substance use disorder are treated like their condition is a personal failing rather than a disease.
- Substance use disorder is split off from the rest of medicine, so the average doctor does not treat it the way they would treat any other chronic condition.
- A caring culture in healthcare encourages patient engagement in treatment by recognizing substance use disorder as a medical condition, not an identity. When we treat all patients with respect, we create a space where people who use drugs can actively seek out and engage in care because they do not fear stigma, judgment, and discrimination when being honest about their history, and even if they start using drugs again.
CA Bridge is leading the charge for universal access to addiction treatment in California.
“I’m loving life again and I am so grateful for your help… I honestly wouldn’t be here thriving today if you wouldn’t have met me at the hospital.”
– Patient note to her navigator at Dignity Health
Publications
Seven Steps for Emergency Physicians to Dismantle Access Barriers and Build Equitable Care Systems
Since 2018, the Bridge Center has helped hundreds of hospitals in California and nationwide implement evidence-based practices that transform the culture of care in emergency departments in just a few short years. This article expands on how clinical champions can utilize the Bridge Center’s seven-step framework to drive meaningful change across diverse healthcare settings.
Scaling emergency department opioid use disorder treatment across California to reduce overdose deaths, 2019–2023
Samuels EA, Rosen AD, Speener M, et al. American Journal of Public Health. Published online June 27, 2024:e1-e5. doi:10.2105/ajph.2024.307710
Emergency department access to buprenorphine for opioid use disorder
Herring AA, Rosen AD, Samuels EA, et al. JAMA Network Open. 2024;7(1):e2353771. doi:10.1001/jamanetworkopen.2023.53771
High-dose buprenorphine initiation in the emergency department among patients using fentanyl and other opioids
Snyder H, Chau B, Kalmin MM, et al. JAMA Network Open. 2023;6(3):e231572. doi:10.1001/jamanetworkopen.2023.1572
Effectiveness of substance use navigation for emergency department patients with substance use disorders: An implementation study
Anderson ES, Rusoja E, Luftig J, et al. Annals of Emergency Medicine. 2023;81(3):297-308. doi:10.1016/j.annemergmed.2022.09.025
Rapid adoption of low-threshold buprenorphine treatment at California emergency departments participating in the CA Bridge program
Snyder H, Kalmin MM, Moulin A, et al. Annals of Emerg Med. 2021 Dec;78(6):759-772. doi: 10.1016/j.annemergmed.2021.05.024.
High-dose buprenorphine induction in the emergency department for treatment of opioid use disorder
Herring AA, Vosooghi AA, Luftig J, et al. JAMA Netw Open. 2021 Jul;4(7):e2117128. Doi: 10.1001/jamanetworkopen.2021.17128.
Voting with their feet: Social factors linked with treatment for opioid use disorder using same-day buprenorphine delivered in California hospitals
Kalmin MM, Goodman-Meza D, Anderson E, et al. Drug and Alc Depend. 2021 May;222. doi: 10.1016/j.drugalcdep.2021.108673.
Sharp decline in hospital and emergency department initiated buprenorphine for opioid use disorder during COVID-19 state of emergency in California
Herring AA, Kalmin M, Speener M, et al. J Subst Abuse Treat. 2021 Apr;123. doi: 10.1016/j.jsat.2020.108260.
Overdose receiving centers – An idea whose time has come
Hern GH, Goldstein D, Tzvieli O, Mercer M, Sporer K, Herring AA. Prehosp Emerg Care. 2021 Feb;26(1): 3-5. doi: 10.1080/10903127.2020.1864073.
Our work is made possible through the support of our current and past funders:
We work closely with our many partners:
- California American College of Emergency Physicians
- California Hospital Association
- California Hospital Compare
- California School-Based Health Alliance
- Cynosure Health
- National Harm Reduction Coalition
- University of California, Los Angeles, Integrated Substance Abuse Programs
- Health Services Advisory Group
- Young People in Recovery
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