In an effort to provide treatment to more patients with opioid use disorder, the Philadelphia Department of Public Health has partnered with Penn Medicine to expand a virtual “bridge clinic” that provides same-day access to lifesaving medication and connection to other recovery services.
“We need to provide services to patients when they are having a treatable moment — if they have to wait several days to see a clinician and start therapy, that moment of change is lost,” said Nicole O’Donnell, a peer recovery specialist with Penn Medicine’s Center for Addiction Medicine and Policy (CAMP). “That’s why this new phase of outreach is a gamechanger.”
Originally set up amid the COVID-19 pandemic’s earliest days, the virtual clinic allows patients to simply use telephone or video visits to get the help they need, including same-day prescription of buprenorphine, a medication that soothes opioid cravings and treats withdrawal symptoms. Buprenorphine also is linked with an increase in long-term treatment engagement and reduces death from overdose and other causes.
“Ensuring patients can make early connections to a peer recovery specialist is a priority for the health department because we recognize how invaluable these health care professionals are in helping address our overdose crisis,” said Jeffrey Hom, MD, medical director of the Division of Substance Use Prevention and Harm Reduction in the Philadelphia Department of Public Health. “Based on Penn’s success with peers and telehealth during two challenging situations – the pandemic and the sudden closure of buprenorphine practices in the city – it made sense to pilot this warmline to help bridge patients to treatment, social services, and harm reduction resources. This type of program has shown promise elsewhere in Pennsylvania and we look forward to seeing the difference it will make in Philadelphia.”
At Penn Medicine and elsewhere, there have been efforts to make it easier for physicians to prescribe buprenorphine as a “bridge” medication to help patients make the transition from contact with acute care settings to further treatment toward long-term recovery. Often, patients make contact via the emergency department or urgent care and are then lost without long-term social or recovery care being established.
But with the COVID-19 pandemic upending all parts of life – and being especially devastating among people with opioid use disorder – the efforts to provide alternative treatment strategies due to clinic closures and limited access took on increased importance. In March 2020, the DEA issued guidance temporarily modifying some regulations for prescribing buprenorphine, which allowed Penn Medicine to launch the first version of the virtual bridge clinic. This allowed patients to access buprenorphine via telemedicine for the first time.
But there was room for growth and refinement of the system. The first version of the clinic was simple: A phone number led to a peer recovery specialist, who then called one of two on-call physicians to secure a prescription. After that, the specialist attempted to guide the patient to long-term care. While this helped dozens of patients amid a particularly dark time, it wasn’t a scalable model.
However, with the new version of the bridge clinic and the Department of Public Health’s investment, Penn Medicine OnDemand – the health system’s 24/7 virtual urgent care telemedicine service – became involved. With the support and engagement from eager clinicians at Penn Medicine OnDemand, a path for quickly and efficiently moving patients through a “warm hand-off” process was created. Penn’s Center for Addiction Medicine and Policy team trained all of the OnDemand clinicians to evaluate patients and start treatment with buprenorphine virtually.
The city’s support also allowed for additional substance use navigators to be hired to guide patients through the whole process. The navigators field the initial call for help, assess patients’ care needs, and link patients to Penn Medicine OnDemand staff, who can provide a same-day buprenorphine prescription. The substance use navigators then link patients to longer-term care and other relevant support. That includes everything from providing naloxone (an emergency medication that reverses overdoses) to counseling, follow-up physician visits, and arranging community services.
“Low-barrier care and treatment on demand could establish a new pathway to protect patients from the risk of fatal overdose in the fentanyl era,” said Jeanmarie Perrone, MD, a professor of Emergency Medicine and the director of the Penn Medicine Center for Addiction Medicine and Policy. “This could be deployed in areas underserved by qualified addiction providers and address urban and rural challenges to treatment access.”
Just over 50 patients have benefitted from the expanded program so far this year and 72 bridge prescriptions were written. The majority of them accessed the program after hearing about it through word of mouth. Almost all of the patients had no insurance or Medicaid.
“We know that rapid access to medications is lifesaving, but there are so many things that get in the way. We wanted patients seeking care to be met with a friendly and knowledgeable person who could get them the care they need without stigma or unnecessary roadblocks, and we needed to find a way do this at scale,” said Margaret Lowenstein, MD, an assistant professor of Medicine. “We believe this is the way we can best accomplish that.”