TREATMENT STARTS HERE:

Resources for the treatment of substance use disorders from the acute care setting

Resources developed and shared by the CA Bridge program were developed by an interdisciplinary team based on published evidence and expert opinion. As the literature develops best practices may change. They should never be used as a substitute for clinical judgement. Individual providers are responsible for assessing the unique circumstances and needs of each case. Adherence to these guidelines will not ensure successful treatment in every situation.

CA Bridge Clinical Toolkit

This toolkit is updated periodically. The most recent version is dated NOVEMBER 2019.

CLINICAL PROTOCOLS

CLINICAL PRACTICE UNDER DEVELOPMENT

  • ACUTE CARE TREATMENT OF ALCOHOL USE DISORDER

    Guidance for hospitals participating in the California Bridge Program who would like to incorporate treatment for alcohol use disorder into their emergency departments and inpatient settings

FREQUENTLY ASKED QUESTIONS

BEST PRACTICES

PATIENT FACING MATERIALS

WAITING ROOM SIGNAGE

Posters for hospital waiting rooms and triage can provide awareness that treatment for acute withdrawal is available which can invite patients to be honest about their illness within the acute care setting

Treating withdrawal from opioid use disorder from within the emergency department is important in order to provide rapid access to anyone seeking treatment. This 20 minute video will walk through the framework of using buprenorphine for treating patients within the ED setting.

 

Training

PCSS X-Waiver Training

Under the Drug Addiction Treatment Act of 2000 (DATA 2000), physicians are required to complete an eight-hour training to qualify for a waiver to prescribe and dispense buprenorphine. Providers Clinical Support System (PCSS) offers DEA X-Waiver training for MAT for physicians, nurse practitioners, and physicians assistants

Additional Resources

REIMBURSEMENT

SAFER PRESCRIBING

SAFER PRESCRIBING FROM THE ED

Between 1997 and 2007 the use of prescription opioids more than quadrupled. Similarly, drug overdose deaths significantly increased for the 11th consecutive year in 2010. Although emergency physicians manage 28% of all acute care visits in the United States, only 5% of all opioid prescriptions are written by emergency physicians. As leaders in health care we are empowered do our part in reversing this alarming public health trend.

California ACEP has endorsed and is promoting the following safe prescribing guidelines that were updated in October 2018 and supported by numerous partners.

Safe pain medicine prescribing (English)

Safe pain medicine prescribing (Spanish)

How to talk to patients about safe prescribing

Helpful prescribing tips

 

Harm Reduction

Promoting the health of those with substance use disorders


 

WORKING EXAMPLES OF HARM REDUCTION TOOLS USED AT SELECTED BRIDGE SITES

Example materials in use at Highland Hospital dispensing naloxone kits to patients of visitors at risk of overdose. For more information contact Josh@BridgeToTreatment.org

 

 
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NALOXONE DISTRIBUTION PROJECT

The Naloxone Distribution Project (NDP) is funded by SAMHSA and administered by DHCS to combat opioid overdose-related deaths throughout California. The NDP aims to address the opioid crisis by reducing opioid overdose deaths through the provision of free naloxone, in its nasal spray formulation. Starting in October 2018, qualified organizations and entities will be able to request free naloxone from DHCS.

 
 

NALOXONE BOOKLET

A step-by-step illustrated guide on how to use a naloxone kit in the event of an overdose.

 
 

HARM REDUCTION COALITION

Harm Reduction Coalition is a national advocacy and capacity-building organization that works to promote the health and dignity of individuals and communities who are impacted by drug use.

 
 

24/7 clinician to clinician support to start medication for substance use disorders

California Substance Use Line: 1-844-326-2626

The California Substance Use Line is a free, 24/7 tele-consultation service for California physicians, nurses, and other clinicians with questions about substance use treatment. It is staffed by experienced physicians and pharmacists who can answer confidential questions about substance use evaluation and management, including medications to treat opioid use disorder. The line is open to any clinician in California and is a collaboration between the Clinician Consultation Center and the California Poison Control System. Open 24/7: (844) 326-2626. Learn more about services offered through the substance line. 

National Substance Use Warm Line: 1-855-300-3595

The Substance Use Warm Line is available for providers from across the United States 6am-5pm (PST) Monday-Friday for non-urgent consultation requests that may be directed to addiction-certified physicians or clinical pharmacists who can provide same-day responses. The Warm Line is open to questions from internal medicine, surgery, pharmacy, anesthesia, primary care/other ambulatory, obstetrics/women’s health practices, and other specialty care. Additionally, a voicemail collects questions on a 24/7 basis.


Policy Resources

OVERCOMING DATA-SHARING CHALLENGES IN THE OPIOID EPIDEMIC: Integrating Substance Use Disorder Treatment in Primary Care 

(July 2018) In response to the opioid epidemic, states and the federal government have sought to increase the availability of substance use disorder (SUD) treatment. Through medication-assisted treatment (MAT) programs and other efforts, primary care practices have taken a more prominent role in providing SUD care. Primary care practices are stepping up to treat addiction due to many factors — recognition of the role of the medical system in driving opioid overuse and addiction, shifting of attitudes about addiction with acceptance of SUD as a chronic disease, and insufficient specialized treatment resources to address growing demands, especially in rural areas. However, common roadblocks for primary care practices are the inability to efficiently and effectively communicate with SUD providers and a lack of clear guidance about how to share SUD and primary care treatment information.

POTENTIAL COST SAVINGS ASSOCIATED WITH SBIRT FOR SUD

(June 2018) The Urban Institute – This report provides a rapid review of evidence on the potential cost savings associated with providing screening, brief intervention, and referral to treatment for individuals with substance use disorders (SUDs) related to alcohol and drug use in emergency departments (EDs).