A National First: Buprenorphine Treatment at Overdose Scenes

A National First: Buprenorphine Treatment at Overdose Scenes

When is the best time to initiate commitment to addiction treatment?

There is no single answer to this crucial question - everyone's different, and the opportunities are just as varied.

In New Jersey, however, state health commissioner Dr. Shereef Elnahal has decided that one of those opportunities is right at the scene of an overdose.

Elnahal has authorized paramedics (only paramedics, not police or other first responders) in the state's 21 mobile intensive-care units to carry Suboxone or a generic equivalent, and use it immediately after an overdose victim has been treated with naloxone.

Too often, paramedics say, the patient is miraculously pulled back from the brink of death by the naloxone, but instead of asking for help getting into treatment, the avalanche of withdrawal symptoms brought on by the naloxone sends the person lurching back into the streets to find another fix.

New Jersey's idea is to use buprenorphine to relieve the immediate and often severe withdrawal symptoms that follow naloxone treatment, hoping it initiates a reach by the patient for longer term medical opioid detox and rehabilitation treatment.

"Buprenorphine is a critical medication that doesn't just bring folks into recovery - it can also dampen the devastating effects of opioid withdrawal," Elnahal explained. "That's why equipping our EMS professionals with this drug is so important."

First in the nation

Calling the buprenorphine program "without precedent in the U.S.," a Stat News report said the NJ experiment "serves as a testament to many states' increasingly aggressive and innovative efforts to reduce drug overdose deaths. And while the announcement came as a surprise to many addiction experts, most applauded the effort."

To safeguard against potential complications, the state's 1,900 paramedics will have to get permission from the ER doctors in charge of their unit each time they want to use buprenorphine in the field. The physicians themselves will require DEA waivers to prescribe buprenorphine, even though they are already licensed to prescribe most controlled substances.

Considering that the DEA approval for prescribing buprenorphine involves physician training programs, requiring from 8 to 24 hours, the state's decision to implement such a program is remarkable.

Pros impressed but questions remain

Andrew Kolodny, a Brandeis University physician who studies addiction, told The Atlantic magazine that it's "a fantastic idea. We'll need to track this closely because I don't think it's been done before. But it's a very promising intervention that could become a new standard of care."

Dr. Dan Ciccarone, a University of California, San Francisco, professor who studies addiction, said, "This comes out of left field, and it's very interesting. It's a potentially brilliant idea."

Although addiction treatment pros are impressed, the program nevertheless has raised some questions, most notably about patient consent.

James Langabeer, an addiction medicine researcher at the University of Texas Health Science Center at Houston, said that obtaining permission from individuals experiencing withdrawal - some in a state of semi-consciousness - "could prove challenging."

"These are not conversations that are easy to have for anybody, and especially for a paramedic. There's a whole set of decision-making processes that the paramedic will have to integrate into their protocol."

Insurance is a concern

Also, patients' insurance will be billed for the administration of the buprenorphine. But what happens when patients don't have insurance?

According to the Kaiser Family Foundation, 11 percent of New Jersey adults are not insured. The insurance question remains to be answered.

Finally, no one can predict what percentage of overdose victims receiving buprenorphine will actually transition to longer-term treatment.

Keith Humphreys, a professor at Stanford University, told The Atlantic that the program "will make a meaningful difference only if rescued individuals are linked immediately to ongoing treatment, and agree to participate in that treatment."

Time will tell how well the NJ buprenorphine program works through its many challenges. Here at Novus, we are especially interested in how well it succeeds as a catalyst for transforming overdose victims into committed patients with a new lease on life, who head straight into medical opiate detox and long-term treatment.

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