For patients arriving at an emergency department (ED) after an opioid overdose, the crisis is often treated as a temporary event.
At Mass General Brigham, however, clinical leaders are shifting that focus, treating opioid use disorder as a chronic, life-threatening condition that demands immediate intervention while the patient is still under medical care.
The health system is scaling an integrated model of addiction care that bridges the gap between emergency medicine and long-term recovery. By combining bedside addiction consultations with low-barrier "bridge clinics," the system aims to ensure that patients who initiate treatment in the ED have a reliable way to continue support after they are discharged.
“So many of our patients come through the ED. It’s a critical touchpoint where we have an opportunity to initiate lifesaving treatment,” said Sarah Wakeman, MD, director of the Program for Substance Use and Addiction Services at Mass General Brigham.
Research indicates that prescribing medications such as buprenorphine—often known by the brand name Suboxone—during an emergency visit can reduce the risk of future fatal overdose by more than 50%.
Building a Systemic Approach
The framework now being expanded across the system originated more than a decade ago at Massachusetts General Hospital. At that time, prescribing addiction medication in an emergency setting was not standard practice, and physicians were required to undergo specialized training.
Ali S. Raja, MD, DBA, MPH, chair of the Department of Emergency Medicine at Mass General Brigham, was among the first to complete the requirements and helped lead the effort to train his colleagues.
“Ultimately, we managed to get almost every emergency physician at Massachusetts General Hospital trained to prescribe buprenorphine,” Raja said. “That allowed us to roll out a program so that patients who needed it could get it from the Massachusetts General Hospital ED.”
The model’s success hinges on a “relay race” approach to patient care. While emergency physicians handle the initial medical stabilization and medication initiation, addiction specialists provide bedside consultations, and bridge clinics—which offer both in-person and telemedicine appointments without requiring prior scheduling—take over long-term management.
This structure ensures that a patient treated in the middle of the night can immediately access follow-up care the next day, preventing the common pitfalls that often cause treatment plans to collapse.
Expansion Across the Network
Mass General Brigham is working to standardize this level of care across its various hospital campuses. While resources and staffing models historically differed by location, the health system is now implementing consistent protocols that include medication access, clinician training, and real-time support from addiction consult teams.
The integration advanced on July 1, when a new interprofessional addiction consult team launched at Brigham and Women’s Hospital. The team provides seven-day-a-week access to specialists, allowing emergency staff to consult with experts at the bedside to determine the most effective treatment strategies for individual patients.
The system is also utilizing federal funding to establish similar consult teams and bridge clinics at other locations, including Cooley Dickinson Hospital. Meanwhile, staff at Salem Hospital are currently undergoing training to align their emergency addiction services with the system-wide model.
Treating Addiction as an Emergency
The treatment of opioid use disorder is now a tracked metric on the emergency department’s High-Reliability Organization (HRO) scorecard.
“Opioid use disorder is like any another emergency condition,” Raja said. “We focus on it just much as we focus on things like stroke and sepsis care.”
As the integration continues, the goal remains to ensure that a patient’s location within the Mass General Brigham system does not dictate the quality of their care. According to Wakeman, the focus is both a clinical necessity and a moral imperative.
“We have these wildly effective tools that have, in the past, been so underutilized,” she said. “But we are lucky to partner with our Emergency Medicine colleagues who recognize that not only can we do this, but we should be doing this.”
