In a new development, paramedics in New Jersey will now be able to administer buprenorphine (Suboxone) to patients immediately after reviving them from an opioid overdose. According to health officials, on-the-spot treatment with Suboxone could facilitate an immediate transition to long-term treatment. This is in addition to addressing the potential withdrawal symptoms of naloxone revival.
In a newly signed executive directive, Dr. Shereef Elnahal, New Jersey state’s health commissioner authorizes only EMTs in the state’s 21 mobile intensive care units to carry suboxone or a generic equivalent. According to him,
“Buprenorphine is a critical medication that doesn’t just bring folks into recovery, it also dampens the devastating effects of opioid withdrawal. That’s why equipping our EMS professionals with this drug is so important,”
Suboxone After Overdose
Suboxone is a prescription medication which is highly effective in treating opioid use disorder. It is formulated from a combination of buprenorphine and naloxone as active ingredients. As an opioid itself, it is regulated as a Schedule III substance by the Drug Enforcement Administration.
In the past, physicians required a special waiver to prescribe and administer Suboxone. However, the new initiative will allow Emergency Medical Technicians to administer a dose of buprenorphine with permission from the emergency room doctor overseeing their unit that has a Drug Enforcement Administration (DEA) waiver. While reacting to the new development in a chat with stat news, a University of California, San Francisco professor, Dr. Dan Ciccarone said:
“The buprenorphine which effectively binds to the same brain receptors as opioids used for pain would provide a soft landing for patients recovering from an overdose.”
He also attested to the directive as a potentially brilliant one.
Do they Need Permission to Use Suboxone?
Arising from this new approach by New Jersey is the question of consent. Commenting on the inherent challenges associated with seeking permission from patients suffering from withdrawal symptoms, James Langabeer, an addiction expert at the University of Texas Health Science Center, Houston said the new approach will require paramedics to integrate new decision-making processes into their protocol. He further applauded the initiative but reiterated that it will only be effective if patients are linked to continuing treatment.
The executive directive by Dr. Elnahal has no precedent in the US and among other questions being asked is: What happens to patients who do not have insurance? To address this, the New Jersey health commissioner hinted that all buprenorphine claims for uninsured patients will be referred to hospitals’ charity-care programs where they can receive treatment for free or at reduced fees.
Currently, it is quite difficult to find a licensed primary care physician to prescribe buprenorphine. While New Jersey has a significant number of medical doctors who have the license to prescribe buprenorphine, only 25 percent of all addiction treatment facilities in the state provide medication-assisted treatment. This stems from the fact that only a few doctors know how to effectively utilize buprenorphine medication. Access to long-term opioid addiction treatment has been challenging as a result. Dr. Elnahal reported that the New Jersey state is actively training more doctors in how to prescribe buprenorphine to address this shortcoming. He also added that the federal requirement to have a license to prescribe buprenorphine would be eliminated.