In 2020, New Mexico established the New Mexico (NM) Bridge—a new initiative to address the state’s rapidly rising opioid-overdose death rate. The NM Bridge partners with hospitals across New Mexico to initiate emergency department (ED) and hospital-based medication for opioid use disorder (MOUD) programs while assuring linkage to community treatment. MOUD programs improve long-term recovery and reduce risk of death by combining FDA-approved drugs with behavioral therapies for people diagnosed with opioid use disorder (OUD).^1,2 Brief intervention and facilitated referral to community-based treatment services is much needed in NM where the opioid overdose rate exceeds the national average, with overdoses reaching an all-time high in 2021 due to illicit fentanyl and exacerbated by the COVID-19 pandemic.³ This is particularly concerning in NM, which is the fifth-largest state in the U.S. by land mass, is highly rural and poor, and has persistent behavioral-health workforce shortages.^4,5 We describe how NM Bridge partnered with rural hospitals to expand access for OUD treatment and behavioral-health workforce across a highly rural state with limited services.

Multifaceted State Response

NM has significant need for OUD treatment, but an inadequate supply of prescribing clinicians.⁵ To address high rates of opioid use and overdose, the state tripled spending and enacted significant policy changes to expand substance-use disorder (SUD) treatment providers, treatment, and harm-reduction strategies.⁶ Yet, the number of prescribers remains low, particularly in rural NM. To address this, the state’s Behavioral Health Service Division allocated funding from the State Opioid Response (SOR) grant to establish the NM Bridge Program. NM Bridge focuses on training hospital physicians and nurses to identify and immediately treat patients using medications (e.g., buprenorphine) for opioid treatment in EDs and helping hospitals establish outpatient follow-up at time of discharge. As rural communities generally lack health care services, the local hospital is a primary treatment location.⁷ Thus, NM Bridge’s focus on expanding prescribers in rural hospitals has an outsized impact on access to medication-based OUD treatment in these communities.

Click to enlarge Table 1.

Medication for Opioid Use Disorder from the ED

Core to the NM Bridge program is the implementation team, whose members have complementary knowledge within emergency medicine, primary care, addiction medicine, medical toxicology, billing/Medicaid reimbursement, nursing education, rural health, and peer support. Importantly, the majority of team members have expertise in providing care and implementing best treatment practices with rural clinicians. (Table 1). The implementation team guides partner hospitals from start to finish in establishing their ED-based MOUD program. The team engages other hospital units (e.g., inpatient and obstetrics) and establishes outpatient follow-up pathways for continued treatment with medication and therapy. Additionally, the NM Bridge established a 24/7 addiction-medicine consult service through the NM Poison Center, available to any clinician in New Mexico.