Starting Treatment When It Matters Most – EMS Bridge Turns Five
When we launched EMS Bridge five years ago, we started with a critical question: What if opioid use disorder (OUD) treatment began in the field from the first point of contact — the paramedic — at the moment patients are most vulnerable? Today, reaching over 6.5 million Californians, we’ve shown it’s possible. By starting treatment in the field, we are bridging the gap between a crisis and long-term recovery.
How EMS Bridge Works
EMS Bridge is a public health-EMS partnership model that empowers paramedics to initiate buprenorphine in the field for patients experiencing opioid withdrawal, while also connecting them to ongoing care. The model combines:
- EMS-initiated buprenorphine to stop withdrawal symptoms.
- Leave-behind naloxone for immediate safety.
- Transportation to CA Bridge opioid-receiving centers (when appropriate).
- Warm handoff to follow-up navigation and support.
In practice, this means that when a paramedic responds to an overdose or a person in withdrawal, they don’t just offer a ride to the emergency room. The paramedic can immediately provide medication to stop the pain associated with withdrawal, provide the patient with a naloxone kit for safety, and contact a navigator to ensure the patient has a follow-up plan for long-term recovery.
“[EMS-initiated buprenorphine] advances equity by bringing gold-standard OUD care to people who may never make it to a clinic, and it aligns with EMS’s evolving role in unscheduled, population-level care,” said a California EMS leader collaborating with the program in San Francisco. “In short, EMS-initiated buprenorphine is humane, clinically sound, operationally feasible, and one of the most meaningful ways we can improve outcomes for patients and communities.”
EMS often serves as the first — and sometimes only — point of healthcare contact for people with OUD. By expanding the role of EMS from overdose reversal to treatment initiation, EMS Bridge fills a critical gap and reduces the risk of repeat overdose.
The Impact So Far
Since starting as a pilot in Contra Costa County in 2020, EMS Bridge has changed how California manages the opioid crisis.
- Our work has helped drive statewide policy change, expanding the paramedic scope of practice.
- Now active in 12 counties, EMS-initiated buprenorphine is accessible to over 6.5 million Californians, and this number is expected to grow with five additional counties exploring an EMS buprenorphine program in 2026.
- From urban to rural settings, the EMS Bridge model has improved patient outcomes and increased job satisfaction for EMS clinicians.
Beyond California
EMS Bridge has supported national adoption through hands-on training led by former EMS providers and is contributing to a national EMS-initiated buprenorphine study sponsored by the National Institute on Drug Abuse (NIDA) and led by Yale University.
Looking Ahead
“[The EMS Bridge Model] is an alternative treatment that actually starts a patient down the road to recovery and out of the spiral of addiction,” said an EMS training participant from Salem, Oregon.
Opioids kill more than 217 Americans every day. The need for scalable, evidence-based solutions is urgent. EMS Bridge’s next chapter focuses on expanding access, strengthening implementation support, and continuing to center equity, harm reduction, and community responsiveness.
EMS Bridge shows that starting OUD treatment in the field is feasible, effective, and transformative — for patients, providers, and systems of care.
Read the full Five-Year Impact Report to learn more about how EMS Bridge is reshaping emergency response to the opioid crisis.