Opioid overdose is a major cause of mortality, and medications such as buprenorphine can reduce the risk of recurrent overdose. Many people who experience overdose are resuscitated by emergency medical services (EMS), but decline transport to the hospital, thus closing a potential link to treatment. Researchers assessed a novel program of post-overdose EMS-initiated buprenorphine over 13 months in one US city. Patients who were resuscitated by a buprenorphine-equipped ambulance (BEA) could receive 16 mg of buprenorphine if they had decision-making capacity after naloxone administration, and had a Clinical Opiate Withdrawal Scale (COWS)* score of ≥5, or had no opioid use in the 72 hours prior to the overdose. A follow-up dose of 8 mg of buprenorphine could be administered if withdrawal continued. Patients who received buprenorphine were given a same or next-day appointment in an addiction medicine clinic. Researchers compared individuals who were treated by a BEA with those who were not to determine recurrent overdose, withdrawal scoring, and outpatient follow-up rates.
- Of the 1230 patients with opioid overdose treated by a BEA, only 97 (8 percent) received buprenorphine.
- Those treated by a BEA had greater odds of engaging with outpatient addiction medicine treatment within 30 days (adjusted odds ratio [aOR], 7.24), compared with patients not treated by a BEA.
- Patients who received buprenorphine from a BEA had a mean initial COWS score of 9 and follow-up score of 3.
- Recurrent overdose rates within 24 hours or 7 days were not significantly different between patients who were treated by a BEA and those who were not.
* COWS scores of 5–12 = mild; 13–24 = moderate; 25–36 = moderately severe; >36 = severe withdrawal.
Comments: Buprenorphine administration by EMS following an opioid overdose is a potential approach to engage individuals in treatment. However, only a small proportion of individuals with overdose received buprenorphine and unfortunately the study does not provide detail on the reasons for lack of treatment with buprenorphine. This study failed to show a significant decline in recurrent overdose, but it was not powered to do so. Nevertheless, this is a creative approach that deserves further study and refinement.
Corey McBrayer, DO, MPH** & Darius A. Rastegar, MD
** Rich Saitz Editorial Intern & Grant Medical Center Addiction Medicine Fellow, OhioHealth.
Reference: Carroll G, Solomon KT, Heil J, et al. Impact of administering buprenorphine to overdose survivors using emergency medical services. Ann Emerg Med. 2023;81(2):165–175.