Bridge clinic implementation of “72-hour rule” methadone for opioid withdrawal management: Impact on opioid treatment program linkage and retention in care

Taylor, Jessica; Laks, Jordana; Christine, Paul J.; Kehoe, Jessica; Evans, James E.; Kim, Theresa; Farrell, Natalija M.; White, Cedric S.; Weinstein, Zoe; Walley, Alexander Y.

doi:10.1016/j.drugalcdep.2022.109497

Cited by 19 publications

(22 citation statements)

References 34 publications

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“…The re-entry period is a time with high risk of overdose death, and better access to MOUD during this time is critical in reducing mortality [ 2 , 6 , 48 , 49 ]. Lack of treatment due to breaks in MOUD continuity may lead to substance use and in turn an increase in mortality risk [ 46 , 50 , 51 ]. Salem et al advocate for the development of multi-level interventions at the individual, program, and societal level help bridge the gap during re-entry [ 52 ].…”

Section: Discussionmentioning

confidence: 99%

“Just fighting for my life to stay alive”: a qualitative investigation of barriers and facilitators to community re-entry among people with opioid use disorder and incarceration histories

Hoffman

Thompson

Gaeta

et al. 2023

Addict Sci Clin Pract

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Background During the period of community re-entry immediately following release from jail or prison, individuals with opioid use disorder (OUD) face structural barriers to successful re-entry and high risk of overdose. Few published studies investigate experiences in the immediate period (i.e., first 24 h) of re-entry among people with OUD. Aim To understand the barriers and facilitators to treatment and reintegration of people with OUD during the initial transition from carceral settings back into the community. Methods From January–December 2017, we conducted 42 semi-structured qualitative interviews with patients with a history of incarceration who were receiving methadone at a not-for-profit, low-barrier opioid treatment program. Interviews probed participants’ community re-entry experiences immediately following incarceration. Interviews were transcribed and analyzed using a Thematic Analysis approach. Results The main themes described the experiences during the 24 h following release, reacclimating and navigating re-entry barriers, and re-entry preparedness and planning. Participants noted the initial 24 h to be a period of risk for returning to substance use or an opportunity to engage with OUD treatment as well as a tenuous period where many lacked basic resources such as shelter or money. When discussing the subsequent re-entry period, participants noted social challenges and persistent barriers to stable housing and employment. Participants overall described feeling unprepared for release and suggested improvements including formal transition programs, improved education, and support to combat the risk of overdose and return to substance use after incarceration. Conclusions In this study that qualitatively examines the experiences of people with incarceration histories and OUD enrolled in methadone treatment, we found that participants faced many barriers to community re-entry, particularly surrounding basic resources and treatment engagement. Participants reported feeling unprepared for release but made concrete suggestions for interventions that might improve the barriers they encountered. Future work should examine the incorporation of these perspectives of people with lived experience into the development of transition programs or re-entry classes.

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Section: Discussionmentioning

confidence: 99%

“Just fighting for my life to stay alive”: a qualitative investigation of barriers and facilitators to community re-entry among people with opioid use disorder and incarceration histories

Hoffman

Thompson

Gaeta

et al. 2023

Addict Sci Clin Pract

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“…We performed the study at Boston Medical Center's (BMC) Faster Paths clinic, a low-barrier bridge clinic for people with substance use disorders. BMC is the largest safety-net hospital in New England ( Boston Medical Center, 2021 ) and the Faster Paths clinic offers same-day access to MOUD and HIV prevention services, including PrEP, with linkage to long-term care settings after stabilization ( Harvey et al., 2021 ; Roy et al., 2021 ; Taylor et al., 2022 ). Faster Paths also provides on-site HCV treatment and referral to primary care or subspecialists such as gastroenterology for patients with co-infection.…”

Section: Methodsmentioning

confidence: 99%

Peer recovery coaching for comprehensive HIV, hepatitis C, and opioid use disorder management: The CHORUS pilot study

Martin¹,

PERRYMAN²,

Bernstein³

et al. 2023

Drug and Alcohol Dependence Reports

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“…Co-location with institutional phlebotomy, insurance support, and outpatient pharmacy services also facilitates rapid initiation of medications and infectious disease testing. Hospital-clinic licensure and resources like secure medication dispensing cabinets facilitate administration of scheduled medications like methadone for opioid withdrawal management under the "72-h rule" [24]. Furthermore, hospital-based program may have the resources to stock and later bill more costly injectables like extended-release buprenorphine, enabling rapid medication initiation [27].…”

Section: Hospital-based Outpatient Bridge Clinicsmentioning

confidence: 99%

“…Overall, 60% had two or more concurrent use disorders [22]. In a separate bridge clinic in Boston, MA, among 142 patients seeking methadone emergency withdrawal management with OTP linkage, 85% tested positive for fentanyl, 66% for both an opioid and a stimulant, and the mean number of substances positive in urine drug screen was 3.0 [24]. Among 393 new patients at the same program, inclusive of all SUDs, two-thirds reported injection drug use and over half had experienced opioid overdose [23].…”

Section: Bridge Clinics Serve Patients With High Clinical Complexitymentioning

confidence: 99%

“…New patients presenting to SUD bridge clinics also have high rates of both known and incident HIV, viral hepatitis, and STI [23]. For example, over 1 in 7 patients seeking methadone emergency withdrawal management in a bridge clinic in Boston, MA has baseline HIV infection, an HIV prevalence almost threefold higher than seen among patients receiving buprenorphine in the same institution's office-based addiction treatment program over a 12-year period [24,43].…”

Section: Bridge Clinics Serve Patients With High Clinical Complexitymentioning

confidence: 99%

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Substance use disorder bridge clinics: models, evidence, and future directions

Taylor

Wakeman

Walley

et al. 2023

Addict Sci Clin Pract

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Background The opioid overdose and polysubstance use crises have led to the development of low-barrier, transitional substance use disorder (SUD) treatment models, including bridge clinics. Bridge clinics offer immediate access to medications for opioid use disorder (MOUD) and other SUD treatment and are increasingly numerous. However, given relatively recent implementation, the clinical impact of bridge clinics is not well described. Methods In this narrative review, we describe existing bridge clinic models, services provided, and unique characteristics, highlighting how bridge clinics fill critical gaps in the SUD care continuum. We discuss available evidence for bridge clinic effectiveness in care delivery, including retention in SUD care. We also highlight gaps in available data. Results The first era of bridge clinic implementation has yielded diverse models united in the mission to lower barriers to SUD treatment entry, and preliminary data indicate success in patient-centered program design, MOUD initiation, MOUD retention, and SUD care innovation. However, data on effectiveness in linking to long-term care are limited. Conclusions Bridge clinics represent a critical innovation, offering on-demand access to MOUD and other services. Evaluating the effectiveness of bridge clinics in linking patients to long-term care settings remains an important research priority; however, available data show promising rates of treatment initiation and retention, potentially the most important metric amidst an increasingly dangerous drug supply.

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Bridge clinic implementation of “72-hour rule” methadone for opioid withdrawal management: Impact on opioid treatment program linkage and retention in care

Cited by 19 publications

References 34 publications

“Just fighting for my life to stay alive”: a qualitative investigation of barriers and facilitators to community re-entry among people with opioid use disorder and incarceration histories

“Just fighting for my life to stay alive”: a qualitative investigation of barriers and facilitators to community re-entry among people with opioid use disorder and incarceration histories

Peer recovery coaching for comprehensive HIV, hepatitis C, and opioid use disorder management: The CHORUS pilot study

Substance use disorder bridge clinics: models, evidence, and future directions

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