A Busy Emergency Department In Downtown LA
Los Angeles is a collection of many cities in one. But nowhere is the contrast between the haves and have-nots starker than in Downtown LA. In the shadow of the skyscrapers housing some of the wealthiest companies and people in the nation is Skid Row, with over 50 blocks of homeless encampments, second in size only to New York City. That’s where you’ll also find a public health crisis—hundreds of accidental overdose deaths each year.
When Dr. Jennifer Zhan first arrived at LA’s California Hospital Medical Center (CHMC) in 2018, she was overwhelmed by the never-ending stream of patients from the sprawling tent city into the busy Emergency Department (ED). Many arrived in acute stages of opioid withdrawal, and there wasn’t anything she could prescribe to help them other than anti-nausea medicine.
In contrast, the Colorado hospital where Zhan completed her medical residency had a robust medication for addiction treatment (MAT) program where it was easy to treat people with substance use disorder and refer them to outpatient treatment the next day. “I was shocked when I moved to LA that the community, with its high rate of substance abuse, didn’t have a MAT program.”
One Doctor on a Mission
Anxious to find a solution, Zhan discovered that the CA Bridge program was redefining how EDs treat patients with substance use disorders across California. She convinced her hospital administrators to let her apply for a CA Bridge grant. At first, they were skeptical, but she persevered, and they finally gave approval. Zhan launched her hospital’s CA Bridge program with a few enthusiastic ED physicians who already had an X-waiver, allowing them to administer MAT to patients. Within a few months, Zhan had encouraged 21 doctors, nearly the entire ED team, to register for an X-waiver. The X-waiver has since been removed and is no longer required to prescribe buprenorphine. The hospital then expanded the treatment model into inpatient, family medicine, and other departments. They’ve also partnered with other primary care clinics in South LA to expand outpatient treatment.
Being part of the CA Bridge program and hearing patients’ stories changed Zhan’s life dramatically. She became instrumental in bringing a new, life-saving model of addiction treatment to her hospital. She also joined the CA Bridge team of regional directors to change the standard of care at hospitals throughout the state. The CA Bridge program helped reinvigorate Zhan’s practice and expand her professional community to include other passionate clinicians driven to save more lives.
Evidence-based Practice
Anecdotally, everyone involved knows the program’s efficacy and has seen how it has improved clinical practice and hospital culture around substance use treatment. Zhan says the next step is to prove it, which is why CA Bridge recently published peer-reviewed research using program data. A study in the Annals of Emergency Medicine, Rapid Adoption of Low-Threshold Buprenorphine Treatment at California Emergency Departments Participating in the CA Bridge Program, demonstrates a high level of interest and success in implementing programs to treat addiction in the ED. The study indicates that every ED can provide addiction treatment, with no significant variation in implementation based on hospital location or teaching status. Changes to ED practice were made rapidly and sustainably, with all 52 sites having operational programs within a year of receiving funding and continuing to treat patients with buprenorphine 9-months past funding.
Moreover, once hospitals implement the program model, patients with the least healthcare access benefit the most. A second study, Voting with Their Feet: Social Factors Linked with Treatment for Opioid Use Disorder using Same-Day Buprenorphine Delivered in California Hospitals, published in the Journal of Drug and Alcohol Dependence, shows that the model reaches traditionally underserved patients. As overdose rates rise rapidly in California, starting treatment in the ED is a scalable strategy to reach individuals at the highest risk.
Every Hospital Can Do It
Zhan emphasizes, “The clinical results show everyone in the nation that this program works.” Given the program’s effectiveness, the California Department of Health Care Services (DHCS) announced $20 million in funding to expand the successful model to two-thirds of the hospitals in California in 2020. Starting in 2022, $40 million in state funding will implement the model state-wide at every California acute care hospital. Zhan’s dream is even bigger. She believes that “every hospital in the country needs a MAT program.”
With people dying from drug overdoses at record levels, there’s no time to waste. Emergency departments must work towards Zhan’s dream to counteract a system-wide nightmare. If you want to be part of the solution, reach out for technical assistance to get started.