Effective treatments for substance use disorder (SUD) can substantially improve patient outcomes. First-line medications like buprenorphine and methadone can decrease opioid fatality rates, infectious disease transmission, and other adverse health consequences,[1] yet barriers to accessing these medications persist, from insufficient program capacity, long wait times, to inadequate support during high-risk transitions, such as emergency department discharge and release from prison and jail.
These challenges have spurred interest in the creation of new, low-barrier models to streamline the induction of medications to treat opioid use disorder (OUD) induction and SUD care delivery, such as bridge clinics.
Bridge Clinic Model
Usually based in emergency departments or outpatient settings, bridge clinics provide rapid initiation of medications for OUD (MOUD), stabilization during high-risk transitions, harm reduction services, and linkage to long-term treatment providers.[2] Patients seeking medication to treat OUD—specifically buprenorphine or methadone, which can be difficult to access in the outpatient setting—and other SUDs can schedule same-day and next-day appointments through a bridge clinic, which increases utilization and retention compared to treatment programs that require scheduling further out. “Bridge clinics reduce the barriers to starting medication for substance use disorders by offering evidence-based treatment on demand,” shared Dr. Alex Walley, Professor at Boston University School of Medicine. “They work by making the treatment work for the patients, instead of making the patients work for the treatment.”
Staff in bridge clinics typically comprise interdisciplinary teams that may include addiction medicine physicians, psychiatrists, nurse practitioners, nurse care managers, social workers, psychologists, case managers, patient navigators, peer recovery coaches, or pharmacists. Some bridge clinics also offer integrated behavioral health services or collaborative referrals to other long-term care settings. Karen Haessler, PA-C, explained, “As a provider for an inpatient Addiction Consult Service, my relationship with the local Bridge Clinic is invaluable. It allows me to treat the whole person and start them on the lifesaving medications of Methadone or Suboxone while they are in a safe place and open to recovery. Knowing they will get good care and their medications will not be interrupted while they are waiting for an appointment at a standard Office-Based Addiction Treatment program or other addiction medicine provider allows me to treat the patient’s addiction immediately and not just treat their withdrawal and hope they can find a place for treatment after discharge.”
Research shows patient preference and endorsement for the bridge clinic model, citing the welcoming clinical environments, flexibility to be seen without an appointment, utilization of harm reduction principles, access to knowledgeable providers who approach addiction care with compassion, and linkage to ongoing care, including peer recovery coaches.[3]
In addition to MOUD, bridge clinics generally offer pharmacotherapy for other types of SUD, such as naltrexone and acamprosate for alcohol use disorder. Some bridge clinics incorporate human immunodeficiency virus (HIV), viral hepatitis, and sexually transmitted infection (STI) screening, treatment, and prevention services like HIV pre-and post-exposure prophylaxis (PrEP, PEP).[2]
When patients are ready, they can be linked to other long-term programs, like office-based addiction programs in primary care clinics.
In order to make treatment truly accessible, bridge clinics often collaborate with other providers and services, such as housing programs, residential addiction treatment, and pharmacies, to reduce barriers. Dr. Walley explained, “If a medication isn’t easily accessible through the pharmacy because a patient doesn’t have an ID, then the bridge clinic team will work to resolve this, by clarifying the regulations around ID requirements and their exceptions, finding a pharmacy willing to work with their patients, making a relationship with that pharmacy, and having an ongoing relationship with them. Further, they will work with the patient to obtain the ID to reduce future barriers.”
Bridge Clinic Models Expand Throughout Massachusetts
In Massachusetts, the Bridge Clinic at Boston Medical Center (BMC) is an inspiring example of the difference that compassionate, patient-centered continuity of care can make for those with OUD. Through the HEALing Communities Study, the BMC bridge clinic model was expanded statewide, creating a low-barrier treatment-on-demand access point for individuals with opioid use disorder in a variety of general medical settings.
MA communities in both Wave 1 and Wave 2 have chosen to develop bridge clinics through HEALing Communities, establishing an innovative treatmenton-demand statewide framework that utilizes evidence-based treatment options.
Dr. Jessica Taylor, Assistant Professor at Boston University School of Medicine, explained, “Bridge clinics fill a key gap for patients who need to start addiction treatment or address other addiction-related needs urgently. In the era of fentanyl, which is driving unprecedented rates of opioid overdose death in Massachusetts, OUD treatment needs to be available on demand, as soon as someone is ready to start it, and bridge clinics are designed to deliver on rapid access to medications. Bridge clinics also support those who might otherwise fall through the cracks of a fractured system during transitions of care. They make the entire continuum of care work better for people with SUD.”
New bridge clinics launched in many different medical settings:
In Lowell, Massachusetts, a city of 115,000 in northeastern Massachusetts, Lowell General Hospital started a Bridge Clinic, convenient to their Emergency Department, to help patients get started onto medications for opioid use disorder right away. Patients might come in after being referred by their primary care provider, be walked over by homeless encampments by outreach workers, or walk over from the Emergency Department in order to connect to the Bridge team. The staff there engaged in innovative clinical work, such as using microdosing protocols to transition patients from active fentanyl use to buprenorphine, but also excelled at expressing compassion, offering food, clothes, and a warm, dry place for often stigmatized individuals trying to engage in addiction care.
In nearby Lawrence, Massachusetts, the Greater Lawrence Family Health Center and the Lawrence Comprehensive Treatment Center (the methadone clinic in town) have partnered to create a bridge program on a mobile health unit. A buprenorphine prescriber sits on the mobile unit along with a clinician from the methadone program who can complete an intake form and walk a patient over to the methadone program to receive their first dose on that same day. This mobile unit-based bridge program has already started enrolling patients, and staff from both programs are enthusiastic about early successes.
In Gloucester, Massachusetts, the Addison Gilbert Hospital team with Beth Israel Lahey Health developed a bridge clinic to provide immediate outpatient follow-up to patients who started buprenorphine in their emergency department and received an ED buprenorphine take-home kit. The bridge clinic also collaborates closely with a patient navigator based at the Gloucester Family Health Center and with outreach teams from One Stop, a harm reduction program, to provide rapid access to medication for other patients.
In Salem, Massachusetts, Salem Hospital created an outpatient bridge clinic that collaborated closely with their expanded inpatient Addiction Consult Service, offering interim visits for patients started on buprenorphine during their hospitalization who could not see a long-term outpatient buprenorphine provider right away after discharge. These services supported the growth of inpatient addiction care delivery, giving clinical teams the confidence to start medication knowing that patients would be able to continue it after discharge even if they encountered challenges seeing a long-term outpatient prescriber right away.
Bridge clinics are increasingly recognized as integral components of the care continuum for people with SUD.
About the HEALing Communities Study
The HEALing Communities Study is a multi-site research study to test the integration of prevention, overdose treatment, and medication-based treatment in select communities hard hit by the opioid crisis. HEALing Communities is funded by the National Institutes of Health (NIH) Helping to End Addiction Long-term (HEAL) Initiative®. Learn more at https://hcs.rti.org.
References
National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Sciences Policy; Committee on MedicationAssisted Treatment for Opioid Use Disorder, Mancher, M., & Leshner, A. I. (Eds.). (2019). Medications for Opioid Use Disorder Save Lives. National Academies Press (US). https://www.nap.edu/catalog/25310/medications-foropioid-use-disorder-save-lives
Taylor, J.L., Wakeman, S.E., Walley, A.Y. et al. Substance use disorder bridge clinics: models, evidence, and future directions. Addict Sci Clin Pract 18, 23 (2023). https://doi.org/10.1186/s13722-023-00365-2
Snow, R. L., Simon, R. E., Jack, H. E., Oller, D., Kehoe, L., & Wakeman, S. E. (2019). Patient experiences with a transitional, low-threshold clinic for the treatment of substance use disorder: A qualitative study of a bridge clinic. Journal of substance abuse treatment, 107, 1–7. https://doi.org/10.1016/j.jsat.2019.09.003