By Hanna Webster
Pittsburgh Post-Gazette
PLUM, Pa. — Plum Emergency Medical Services (EMS) has partnered with Allegheny Health Network Forbes Hospital and Forbes Family Medicine to launch a harm reduction pilot program, announced by AHN in a Thursday news release, to prevent fatal overdoses and encourage people to enter opioid use disorder treatment.
The program aims to catch those most vulnerable post-overdose who decline transport to the hospital. EMS have been trained to administer the medication buprenorphine (brand name Suboxone) following an overdose to help stabilize patients, and then provide an assisted handoff to treatment. Buprenorphine partially activates the brain’s opioid receptors, so it can quell withdrawal symptoms.
Typically, first responders give patients the overdose-reversal medication naloxone (Narcan) and then recommend hospital transport. Those who decline to visit the emergency room post-overdose are at risk of overdosing again. As many as 29% of patients refused hospital transport in Pennsylvania in 2022, per a report by the Center for Rural Pennsylvania.
“We know that overdose and overdose death rates are still very high,” said Greg Ferenchak, a faculty physician at Forbes Family Medicine who helps run the opioid treatment clinic there. “When we can get people into treatment early, they’re more likely to remain in that treatment.”
The new program has been in the works for 10 months, said Brian Maloney, director of operations at Plum EMS, and has involved coordination with hospital staff, harm reduction experts and trainings during EMTs’ daily shifts.
A suburban area like Plum isn’t immune to the opioid crisis and the overdose deaths that often occur as a result, said Mr. Maloney.
“In my 25-year career, I’ve [responded to calls] in multimillion-dollar homes and to people living on the streets,” he said. “This affects everybody.”
He originally heard about this style of program during an EMS leadership conference in Texas last year.
“I fell in love with the idea, and I thought, ‘Why isn’t this something we’re already doing?’” said Maloney. He volunteered with the syringe service and harm reduction clinic Prevention Point Pittsburgh for many years and said he began to see these patients “through a different perspective.”
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Dr. Ferenchak said there are very few programs in the country that allow first responders to administer buprenorphine in addition to Narcan during an overdose response, the latter of which can hurl people into withdrawal upon regaining consciousness.
A Plum EMS overdose kit contains buprenorphine (front), Narcan nasal spray and fentanyl and xylazine testing kits.( Sebastian Foltz/Post-Gazette )
A 2022 retrospective study conducted on a similar program in Camden, N.J., found that those given buprenorphine after overdosing were between two and 13 times more likely to engage in opioid use disorder treatment.
In Allegheny County, 13% of patients who were given Narcan by first responders in 2023 refused hospital transport, per Allegheny County Health Department Overdose Dashboard data, representing hundreds of residents. This only includes overdoses recorded by the county, not those that occur in secret or that are not reported to first responders.
“Transporting patients to the hospital isn’t always the best move,” said Mr. Maloney. “A lot of them don’t want to go. We have an opportunity now to say, ‘We can start this and get you in the pipeline for treatment.’”
Dr. Ferenchak worried that stigma could prevent the community from accepting a program like this at face value.
“When you look at what we’re trying to actually achieve with this, we’re helping people access treatment for a medical condition to prevent a fatal overdose,” he said. “It’s pretty easy to see that it’s something we should be doing more often.”
Mr. Maloney said he has been pleasantly surprised with the response of the Plum paramedics and EMTs during training. Learning how to administer buprenorphine is one thing, but building rapport and trust with a person who may have negative associations with hospitals or with medical staff is another.
The team, however, has gone from skeptical to “all in,” he said.
“Everybody has been very open to the idea of, ‘What more can we do for our patients?’ This is a group of people willing to think outside the box, and I can’t give them enough credit.”
Dr. Ferenchak said the team will reassess the success of the pilot program in one year.
AHN Forbes Hospital hopes to soon use funding it’s been given to help patients without insurance get access to opioid use disorder treatment.
“I really do think this program has the potential to impact people who need it the most,” Dr. Ferenchak said. “If we can ultimately prevent even one overdose, that’s a significant impact.”
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