Table 1.

Comparison of three models that link emergency care and addiction treatment.

Model	Description	Benefits	Challenges
ASSERT model	Peer support staff or community health workers in the ED directly refer patients with OUD to local addiction treatment services.	Peer-centered approach Leverages community resources rather than creating resources in the hospital system	Limited by community resources ED clinicians are not the primary staff members interacting with the patient on their use disorder, thereby potentially displacing the responsibility of treating patients with OUD in the ED onto other providers Licensure and scope of practice for the support staff vary considerably between states
Bridge model	Prescribing physicians in the ED screen patients for OUD, provide a short-term prescription for buprenorphine, and then refer the patient directly to an outpatient Bridge clinic that is co-located in the same hospital but is separate from the ED.	Co-location of ED and Clinic potentially reduces likelihood of no-shows Reduced barriers to entry into evidence-based clinic Communication through shared EHR	Clinic capacity is a constraint Excellent coordination between ED and Clinic is paramount to establish effective handoff Significant investment required by health system to create the Bridge Clinic Cost of the 8-hour waiver training for ED clinicians No continuity of care between prescribing clinician in the ED and prescribing clinician in the Bridge Clinic
ED-Bridge model	Physicians trained in both emergency medicine and addiction medicine both screen at-risk patients in the ED, often starting treatment in the ED, and also are able to longitudinally follow patients in the outpatient setting.	Enhanced continuity of care Decreased need for a separate, trained workforce of outpatient addiction clinicians	Highly specialized emergency physicians double boarded in emergency medicine and addiction medicine, leading to a limited supply of providers Likely limited to major urban/academic centers

ED, emergency department; OUD, opioid use disorder; EHR, electronic health records.