Contributed by the C. Kenneth and Dianne Wright Center for Clinical and Translational Research

Emergency departments across the United States experienced a surge in opioid overdose cases during the pandemic. Now, a program at VCU Health aims to help those patients receive the treatment they need after they leave the emergency department.

The new VCU Health Virtual Bridge Clinic creates a direct link between the emergency department and treatment programs for patients with opioid use disorder. Providers use tools such as telehealth services, which were strengthened during the pandemic, to create an immediate support network for people in withdrawal or experiencing an overdose.

Funded by a federal grant administered by the Virginia Department of Medical Assistance Services, program leaders hope to create a unique and successful model for intervention — at a time when the need couldn’t be greater.

“We’re trying to send patients out of here with hope,” said Katy Wells, R.N., nurse clinician for addiction medicine. “They have an expectation that there’s something on the other side of this.”

Addressing ‘a pandemic within a pandemic’

The COVID-19 pandemic worsened an existing crisis in opioid use disorder. Nonfatal opioid overdose visits to the VCU Medical Center emergency department increased from 102 between March and June 2019 to 227 between March and June 2020. National statistics for 2020, released in December by the Centers for Disease Control and Prevention, show sharp increases in overdose deaths as well.

The Virtual Bridge Clinic features two medical components:

• In the emergency department, providers will start patients on buprenorphine, a medication that can help treat addiction, when it’s medically indicated.
• And providers immediately schedule patients for a follow-up visit with a newly-assembled team at VCU Health’s Multidisciplinary Outpatient Intensive Addiction Treatment (MOTIVATE) Clinic

Opened in 2017, the MOTIVATE Clinic provides compassionate, integrated care to patients with substance use disorders. Staff work with people to address both the medical and environmental causes of the patient’s disease.

But getting people there from the emergency department can be a challenge.

“Discharging a patient from the emergency department with a piece of paper that says, ‘Call the MOTIVATE Clinic,’ will often fail,” said Brandon Wills, D.O., associate professor in the VCU Department of Emergency Medicine. “Versus discharging a patient saying, ‘You have an appointment tomorrow morning at 10 a.m. with a doctor or a nurse practitioner. And we’re going to start treatment today.’ That just has a different feel.”

The Virtual Bridge Clinic, which began in April, provides the staffing to do that. It helps train emergency room providers in knowing when patients are presenting in withdrawal and gets them comfortable with prescribing and administering buprenorphine. And a team of specialists will help make sure the patient connects with MOTIVATE.

“Before I hang up the phone with them, they're scheduled for an appointment with the provider and a therapist,” said Tracy Davis, a nurse practitioner and researcher. “And I really drive home that they need that therapy component to be successful in their recovery.”

Wills is leading the program with the help of Wells, Davis and others.

The sheer volume of overdoses, Davis added, makes the need for a program like this unprecedented. “We’re witnessing a pandemic within a pandemic.”

Staffing and telehealth make the program possible

The Virtual Bridge Clinic is unique in the breadth of expertise deployed to create comprehensive care for people experiencing opioid use disorder.

Beyond psychiatrists and mental health specialists, staff includes a social worker, who can help patients navigate challenges in their daily life, as well as nurse practitioners, who coordinate care.

“This is a complicated disorder with lots of moving parts,” Wills said. “A lot of patients who relapse from opioid use disorder are driven by social issues and stressors, like lack of employment and isolation.” 

Program administrators report that this element of the program is already having a positive effect.

“I talk to patients about how our care coordination and social work group is there not only for their mental health needs but their social needs as well,” Davis said. “And you hear the sigh of relief in their voices. They’ll say, ‘That’s great to hear because I need help with food,’ or ‘I need help with housing,’ or ‘I need help with a job.’”

Program leaders hope to add peer-to-peer support to the program soon — that is, having people who’ve recovered from substance use disorders available to provide a peer network for patients.

“The big picture is the whole person,” Wells said. “You can’t just fix one component and leave them destitute in all the other areas because then you've really done nothing for them.”

In addition to staffing, the Virtual Bridge Clinic uses telehealth, which has proven very successful throughout the pandemic.

“Without the pandemic, we probably wouldn’t be where we are now with telehealth,” Wills said. “And I don’t think this program would be possible without the robust telehealth platforms we have now.”

Telehealth can mean anything from a simple phone conversation between the patient and provider to a consultation at a clinic where the doctor or specialist is remote and conferenced in via video.

For the Virtual Bridge Clinic, it’s a convenient way to reach patients who may have transportation issues or may not be able to leave the house that day.

Bringing culture change and plans to expand

For Virtual Bridge Clinic leaders like Wills, Davis and Wells, the final piece of the puzzle is continuing to effect culture change around the patients they’re seeing. They want to help people understand that substance use disorders are just that — disorders.

“Opioid use disorder is a life-threatening disease that requires treatment,” Wills said.

“This project is about translating what we know from years of addiction research and clinical experience into better patient care,” said F. Gerard Moeller, M.D., principal investigator for the Virtual Bridge Clinic and director of the VCU Institute for Drug and Alcohol Studies. “The goal is to develop and test a new standard of care.”

VCU Health hopes the program can be a model for other health systems. Leaders of the clinic hope to expand into other substance use disorders and offer services in different locations, such as Tappahannock and South Hill.

“Access to the Richmond-based MOTIVATE Clinic for those outside the metro area has always been a barrier to the expansion of care that the clinic provides,” Moeller said. “With strengthened telehealth capabilities and this program in place, we can reach patients in more rural areas.”

The grant for the Virtual Bridge Clinic program is part of the SUPPORT Act for substance use disorder prevention, which promotes opioid recovery and treatment for patients and communities through the U.S. Centers for Medicare and Medicaid Services.

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