The Virginia Department of Medical Assistance Services announced plans to expand emergency-department "discharge bridge" programs and a statewide naloxone take-home effort with funding and technical assistance supported by the Virginia Opioid Abatement Authority.

Jason Lowe, addiction and recovery treatment services program manager at DMAS, said the agency received an initial $150,000 award that was carried forward because of implementation delays and has since been granted $1,050,000 for the 2024–25 period of performance, with $900,000 designated for awards to hospitals and health systems. "What would be really useful was funding to the hospitals to help be able to defray those costs," Lowe said, describing needed EHR and pharmacy work to operationalize hospital-based bridge clinics.

The funding builds on DMAS's earlier work under a 2019 Centers for Medicare & Medicaid Services SUPPORT Act grant that helped expand treatment capacity and the workforce. Lowe described partnerships with Carilion Clinic in Roanoke and Virginia Commonwealth University, which are using DMAS and state public health resources to pilot, evaluate and spread ED-initiated treatment models.

Carilion clinicians described the local model and its outcomes. Dr. Sherry Hartman, project lead for Carilion's ED bridge expansion, said the ED is a pivotal point to reach people after nonfatal overdose and to link them quickly to ongoing care. "This chronic yet progressive disease that ultimately can be fatal is treatable," she said, citing quality-improvement tracking that showed high initial rates of successful linkage when patients were referred directly to the hospital's own outpatient program.

Dr. David Hartman, boarded in psychiatry and certified in addiction medicine, described the clinical workflow used at Carilion: screening and diagnosis in the ED, Clinical Opioid Withdrawal Scale (COWS) assessment, and initiation of buprenorphine–naloxone for patients meeting the withdrawal threshold (COWS ≥ 8) with peer support and a rapid referral to outpatient treatment. Clinicians noted that methadone remains an option when preferred by a patient but that buprenorphine–naloxone is commonly used in the ED because it can be started and bridged to outpatient care.

Carilion's quality-improvement data covering the program's early years showed bridge-to-care rates of roughly 78–82 percent when referrals were to its on-site clinic; linkage rates fell as more referrals went to external clinics and as tracking of external sites became harder. Program leaders identified three factors that predicted successful transitions: initiation of buprenorphine in the ED, rapid access to follow-up appointments and peer support, which the team said doubled the odds of successful linkage in early cohorts.

The team described a training and implementation toolkit that includes sample protocols, EHR decision trees and "click-and-play" video modules, and they offered site visits and technical assistance for hospitals selected for awards.

Separately, Dr. Brandon Willis of Virginia Commonwealth University described the Virginia naloxone take-home project, which aims to have naloxone kits dispensed from emergency departments at discharge. The project, operationalized with an OAA-funded project manager and toolkit, has enrolled about 40 EDs to date and supplies naloxone kits and implementation guidance. "We want naloxone to be available and given to patients at the time of their discharge," Willis said, citing models from Colorado and initial data on ED-dispensed kits.

Speakers identified recurring operational barriers to ED naloxone distribution and to ED-initiated treatment: EHR builds (Epic/Cerner), pharmacy workflows and automated dispensing cabinet integration (Pyxis/Omnicell), plus the need for buy-in from pharmacy directors and ED medical leadership. Project staff said the OAA funding covers initial kit distribution and technical assistance, and they described a phased plan that includes scaling to more EDs and pursuing sustainability strategies such as payer coverage of kits.

In a question-and-answer segment attendees asked about risks of precipitated withdrawal with home induction, patient self-assessment using COWS, and insurance/formulation switches. Clinicians described patient education strategies, rare occurrences of precipitated withdrawal (managed with additional buprenorphine doses) and case-by-case adjustments when switching formulations such as to buprenorphine–naloxone films or patches. On federal policy timing, speakers noted that certain actions depend on Centers for Medicare & Medicaid Services guidance tied to federal legislation and urged participants to watch for forthcoming CMS direction.

DMAS said it will publish a request for applications later this year and intends to award between two and four hospital-level grants depending on submissions; details of the RFA were not available at the webinar. Presenters said recordings and slides will be posted on the Opioid Abatement Authority's Abatement Academy page and provided contact information and a QR code to access the ED bridge training toolkit.