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A simple change in state law could bring more opioid users into treatment
A plan for paramedics to administer buprenorphine and connect patients to follow-up care will save lives.
By: Michael W. Dailey, Kathleen Hallinan and Joshua Lynch
March 24, 2024
Using medication to treat opioid use disorder saves lives. It allows people who were suffering from addiction to feel normal, to have fewer cravings, and to be safe from having to obtain drugs on the street that may be laced with deadly doses of fentanyl or other drugs. This legislative session offers a chance to make this care option more accessible, boosting equity in health care and connecting more people with long-term addiction treatment.
Currently, if paramedics are called to the scene of an overdose and administer naloxone, Narcan, to save a person’s life, they may cause the patient to immediately regain consciousness and experience sudden, acute “precipitated” withdrawal. This is a condition in which patients are severely nauseated and sweating, have horrible abdominal cramping and often diarrhea, and feel fluish — in other words, they feel miserable.
The result? The patient often will use opioids again, and the cycle continues.
There’s another option: Paramedics could also administer a medication called buprenorphine, or Suboxone. This medication, which has been used safely and effectively for over a decade in the outpatient setting, takes away the uncomfortable withdrawal symptoms of people who are trying to stop taking opioids. Buprenorphine reverses withdrawal symptoms without causing a “high.”
And critically, the use of buprenorphine therapy by medical first responders — outside of a hospital setting — is an opportunity to engage a subset of patients who would not otherwise receive buprenorphine therapy or a bridge to recovery resources.
However, paramedics aren’t authorized to administer buprenorphine.
New York has an opportunity to change that. Gov. Kathy Hochul’s executive budget adds paramedics to the list of practitioners allowed to administer buprenorphine under the order of a physician or licensed provider. We urge the Legislature to include this language in the final budget and allow New York to join other states that are already pursuing this prehospital treatment strategy to save patient lives.
To be clear: Treatment will not stop at the EMS level. This concept is comprehensive, and these patients must follow up with outpatient treatment.
In January 2023, the New York State Emergency Medical Advisory Committee and the State EMS Council approved a program to initiate buprenorphine administration by EMS providers in the prehospital setting, combined with referral to definitive care.
Patients are eligible for treatment under this program if they have a reported history of chronic opioid use or have experienced an opioid overdose requiring the administration of naloxone and exhibit signs of opioid withdrawal. The EMS provider will explain the prehospital buprenorphine program to the patient and counsel him or her on the benefits of buprenorphine. If the patient consents, the paramedic will contact a physician to receive authorization to administer buprenorphine. The paramedic will also coordinate follow-up through the Medication for Addiction and Electronic Referrals (MATTERS) program.
This program, affiliated with the state Department of Health, will not only connect patients with physicians who can guide their ongoing care; it also will also engage local peer resources to assure there will be support and transportation to get the patient to a follow-up appointment.
The EMS and referral portions of this program are ready to go. All that’s needed is for the state to authorize paramedics to administer buprenorphine.
This harm-reduction approach would encourage adoption of this vital therapy by previously underserved patients who frequently decline transport to a hospital and who may not otherwise be engaged in care. It would help address disparities in health care delivery for impoverished rural and urban populations. And similar programs in New Jersey, Texas and California are seeing resounding success.
Currently, EMS agencies carry and administer other controlled substances in compliance with approved patient care protocols. Buprenorphine would have similar oversight if added to the formulary of medications carried by EMS. We also propose a more stringent and broad-based review of these patient interactions by a physician oversight committee to assure this program’s success.
Please assist us in caring for people with opioid use disorder by adding paramedics to the list of professionals who can administer this important medication. The EMS community stands ready for this next opportunity to care for our vulnerable patients.
Dr. Michael Dailey is chief of prehospital and operational medicine and professor of emergency medicine at Albany Medical College. Dr. Kathleen Hallinan is a volunteer firefighter and a physician at the Corning Guthrie Clinic. Dr. Josh Lynch is an emergency physician, a paramedic, and chief medical officer of MATTERS, mattersnetwork.org.
