An average of 25 patients addicted to opioids are admitted to University Hospital's ER each month.

Before the creation of the Bridge Program in 2019, those patients would have their overdose reversed with the medication naloxone or their severe medical problem stabilized—then be discharged back to whatever complicated life had landed them there in the first place.

That system was not designed to treat the underlying issues that cause addiction—or the myriad struggles that patients face with housing, work, transportation, and nutrition. Such a harsh reality only set addicted patients up for failure.

Sometimes the ER would ask a patient to fill out an intake form and then return in a few days—or even weeks—to see an addiction specialist.

That’s why the Bridge Program is such a game changer for opioid-addicted patients in acute crisis. In the ER, they are immediately prescribed Suboxone, a medication that blocks their symptoms of withdrawal. They then work with case managers and prescribers for up to 30 days, building a bridge from the ER to dedicated treatment services, including peer-supported programs.

This rapid approach to treatment has vastly improved outcomes for patients with opioid dependency, says Rebecca Hyde, MA, who oversees recovery services at Huntsman Mental Health Institute. Without adequate physical and especially mental health care, the odds of recovery from opioid dependency are less than 50%. But of the 2,000 patients admitted to the Bridge Program in its first two years of operation, 61% followed through with subsequent appointments for additional health care—a remarkable improvement in the field of addiction medicine, Hyde says.

“The way I think of it is, addiction is like being chained to a cement block at the bottom of a pool. You can try to swim, but you’re chained to this cement block. Suboxone is a tool that cuts that chain; once the patient is above water, therapy is where they learn how to swim to the side of the pool and get out.”

-Rebecca Hyde, MA, patient services manager at Huntsman Mental Health Institute

While Hakala herself was in recovery and working as a peer support specialist by the time the Bridge Program began, she's intimately familiar with it. After launching in 2019, phone calls from the Bridge Program came in so frequently that she and her co-workers on the USARA ARCHES team had an epiphany: They should wait in their cars at the University Hospital parking lot for the next one to come in instead of wasting time driving back to their offices. They knew that timing was everything when it comes to addiction. And they wanted to be there so that the patient's first step toward recovery could start immediately.

The science of addiction is still uncertain, but a handful of critical factors have become increasingly clear. Genetics and family history play a role—most people who develop a dependency have a blood relative who has struggled with addiction, according to Elizabeth Howell.

“Trauma is also a huge risk factor for addiction. It can change the brain in a way that makes you much more susceptible to wanting to use drugs or losing control over your use. Once you start using regularly, the brain doesn’t react the same to normal things in our lives.”

Another commonality is a history of unmitigated stress or anxiety, which can manifest as chronic, physical pain. Opioids may provide the first relief a patient has experienced in years. It doesn’t take severe trauma like abuse or combat to trigger this, Rebecca Hyde says. It could be as simple as raising kids, financial pressures, a failing marriage, or the fact that your parents divorced when you were young.

The final factor, Howell says, is exposure—which, for most opioid users, generally involves some kind of medical event such as an accident or surgery that prompts a prescription for painkillers. Injuries caused by athletics or working in jobs that require hard physical labor are also common. “[Addiction] has nothing to do with class or intelligence or any of that stuff,” Howell says. “It’s just like how any of us can get diabetes.”

Back pain served as the triggering event for Steve, who asked not to be identified by his real name while he searches for work after getting sober. After years of working in construction, Steve took a job at a warehouse moving 100-pound boxes in and out of a freezer.

One day, a co-worker overheard his frequent complaints about back pain and offered to share his pain prescription to help him get through the workday. Steve knew there was a risk of dependency due to his family history, but in that moment, the pain in his back was so severe that nothing else mattered. “I took them and felt like a million bucks,” Steve says. “I’d go home and clean my whole house—it was great.” He figured that, as long as he was still working and paying his bills, he could “handle the drugs.”

Before too long, the co-worker’s doctor got wise that something was amiss and refused to refill the prescription. Then the co-worker showed up with a $10 bag of heroin. Steve never thought he’d use heroin. But facing withdrawal and the return of his back pain, he told himself this was a one-time deal. “It happens so slow and then so fast,” he says. “By then, I was strung out and had to get well, so I thought I’d just smoke a little bit until I could get a pill.”

Jessie Hakala struggled through seven years of addiction. After two attempts at rehab and a stint in jail, she finally received successful treatment with Suboxone and a spinal block to stop her back pain. Committed to rebuilding her life, she’s now been sober for almost six years and continues her career as a substance abuse care coordinator.

“It takes, on average, six to 10 treatment centers before people actually get into long-term recovery,” she says. Before each of those rehab attempts come the multiple ER visits someone like Hakala once endured. Working with the Bridge Program to reduce that time and help others achieve recovery faster, she says, is an honor.

“I have true connections with people,” Hakala says of her life today. “I have hard days, but overall, I’m happy. I can buy my own car, I can buy food, I can take my kids to the movies.”