Frontiers in ED Addiction Care

Despite an accumulation of evidence that emergency department (ED) substance use disorder interventions are effective, implementation in hospitals nationally has been limited. The California Bridge program works towards a goal of 24/7 access to compassionate, evidence-based care for people who use drugs in every California hospital. At each of more than 150 CA Bridge hospitals, substance use navigators support people who use drugs and clinicians offer rapid initiation of buprenorphine. After establishing these programs, many hospitals work to establish a more comprehensive approach to all substance use disorder treatment. This presentation will address key advances in ED care of people who use drugs and alcohol beyond navigation and buprenorphine, based on the experience of the CA Bridge Centers of Excellence, a consortium of hospitals working on innovative practices in emergency care of people who use drugs. The presentation will focus on novel quality improvement initiatives that could be replicated at hospitals nationally.(1) In the era of fentanyl, the decision between micro and macrodosing initiation of buprenorphine has become more complex. Presenters will discuss approaches to ED initiation of medications for opioid use disorder in daily fentanyl users, including high dose buprenorphine starts, methadone starts, and management in rare cases when precipitated withdrawal does occur. (2) While opioid use disorder has been the traditional focus of ED addiction medicine efforts, a majority of patients with SUD presenting to the ED have either stimulant use disorder or alcohol use disorder. Presenters will discuss approaches to these conditions including ED initiation of naltrexone and support for patients with stimulant intoxication. (3) As overdoses have surged, it has become even more evident that harm reduction is a key component of ED care. Presenters will discuss best practices for ED naloxone distribution and safer consumption kit distribution.In this interactive presentation, presenters and participants will work together to determine practices that can be implemented in EDs nationally. Participants will also be provided with access to toolkits and patient facing handouts to guide implementation at their own sites.