Bridging the Gap: Opioids and the Emergency Department

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By News Team on December 12, 2021
  • Opioid overdose fatalities continue to rise, with 2020 the deadliest year in Virginia’s history.

  • Entering its third year, Carilion Clinic's pilot ED Bridge to Treatment program has an 80% success rate.

  • We are now helping other health systems develop programs like ours.

Almost 2,000 Virginians died of opioid overdose in 2020, and the rate of overdose fatalities in the Roanoke region—80 per 100,000—exceeded the state rate.

As stark as those numbers are, they would likely have been higher if not for Carilion Clinic's groundbreaking ED Bridge to Treatment program.  

Since it was established in late 2018, patients who come to the Emergency Department (ED) with opioid-related infections, withdrawal or overdose may be treated with buprenorphine to start them on the path toward disease management and recovery. They are then connected with peer counselors who understand their situation and give them the confidence to know they can recover.

Before the program started, patients with opioid-use disorders had long wait times to enter outpatient or inpatient programs, and medication-assisted therapy was only effective in the short term. But once the program began, it saw immediate success: None of the first 44 patients who successfully crossed into treatment returned to the ED.

"The program has exceeded our expectations and we are on the cutting edge; we're making a tremendous difference in lives," said John Burton, M.D., chair of Emergency Medicine. 

That initial success has continued in the two years since, even under the added stress of the pandemic:

  • In the first year, 82% of patients appropriate for outpatient care successfully crossed the “bridge” from the acute care ED setting into the office-based opioid treatment program. 
  • In the second year, this success rate remained high at 78%.

"Patients referred to us from the ED now talk about their positive experiences, how respectfully they are treated and how helpful the providers are; they express a new level of hope for getting well," said David W. Hartman, M.D. "The ED Bridge provides a healthy pathway paved by hope for recovery.”

Leading Virginia’s Fight Against Overdose Fatalities

Carilion Roanoke Memorial Hospital is one of the first hospitals in Virginia to use the ED to initiate treatment for opioid addiction. 

The pilot program is funded through the Virginia Department of Health and charges Carilion with informing, instructing and inspiring other EDs to create similar programs to help combat the opioid crisis throughout Virginia. This replication project is funded by the Virginia Department of Medical Assistance Services (DMAS).

Together we have designed an educational curriculum for other EDs to develop and implement bridge clinics unique to each health system. Participant systems will receive free training tools, including access to a free training video, as well as technical assistance from Carilion. 

Watch a short version of the training video above, and follow this YouTube link to view a longer version. 

For more information on the opioid epidemic, visit the Centers for Disease Control and Prevention and the Virginia Department of Health

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