Impact of Administering Buprenorphine to Overdose Survivors Using Emergency Medical Services

• Published in: Annals of emergency medicine Vol. 81; no. 2; pp. 165 - 175
• Main Authors: Carroll, Gerard, Solomon, Keisha T., Heil, Jessica, Saloner, Brendan, Stuart, Elizabeth A., Patel, Esita Y., Greifer, Noah, Salzman, Matthew, Murphy, Emily, Baston, Kaitlan, Haroz, Rachel
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2023
• Subjects: Analgesics, Opioid - therapeutic use; Buprenorphine - therapeutic use; Cohort Studies; Drug Overdose - epidemiology; Emergency Medical Services; Humans; Narcotic Antagonists - therapeutic use; Opioid-Related Disorders - epidemiology; Retrospective Studies; Substance Withdrawal Syndrome - drug therapy
• ISSN: 0196-0644; 1097-6760
• DOI: 10.1016/j.annemergmed.2022.07.006

To evaluate the efficacy and safety of utilizing emergency medical services units to administer high dose buprenorphine after an overdose to treat withdrawal symptoms, reduce repeat overdose, and provide a next-day substances use disorder clinic appointment to initiate long-term treatment. This was a retrospective matched cohort study of patients who experienced an overdose and either received emergency medical services care from a buprenorphine-equipped ambulance or a nonbuprenorphine-equipped ambulance in Camden, New Jersey, an urban community with high overdose rates. There were 117 cases and 123 control patients in the final sample. Compared with a nonbuprenorphine-equipped ambulance, exposure to a buprenorphine-equipped ambulance was associated with greater odds of engaging in opioid use disorder treatment within 30 days of an emergency medical services encounter (unadjusted odds ratio: 5.62, 95% confidence interval, 2.36 to 13.39). Buprenorphine-equipped ambulance engagement did not decrease repeat overdose compared to the comparison group. Patients who received buprenorphine experienced a decrease in withdrawal symptoms. Their clinical opiate withdrawal scale score decreased from an average of 9.27 to 3.16. buprenorphine-equipped ambulances increased on-scene time by 6.12 minutes. Patients who encountered paramedics trained to administer buprenorphine and able to arrange prompt substance use disorder treatment after an acute opioid overdose demonstrated a decrease in opioid withdrawal symptoms, an increase in outpatient addiction follow-up care, and showed no difference in repeat overdose. Patients receiving buprenorphine in the out-of-hospital setting did not experience precipitated withdrawal. Expanded out-of-hospital treatment of opiate use disorder is a promising model for rapid access to buprenorphine after an overdose in a patient population that often has limited contact with the health care system.