How paramedics can open the door to long-term recovery with buprenorphine
By leveraging naloxone and buprenorphine, along with behavioral therapies, medication-assisted treatment attacks opioid addiction from all sides
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By Ryan Kelley
According to preliminary data released by the Centers for Disease Control this summer, 2018 was the first year in almost 30 years in which the number of drug overdose deaths decreased. The data shows that 2017 saw an alarming 70,000 overdose fatalities, while that number shrank slightly to 68,000 in 2018.
So, does this mean the opioid epidemic is gradually weakening? Not exactly, but it does mean we’re finding better ways to fight back. In addition to the fact that doctors are now prescribing fewer high-dose opioids than in the past, many attribute the decline in overdose deaths to naloxone. Statistics from the CDC show that the number of naloxone prescriptions doubled from 2017 to 2018. For paramedics and other first responders, this drug is providing a way to save lives – at least, in the short term.
Naloxone alone is not enough for opioid addiction recovery
As promising as naloxone truly is, this medication has a downside when used alone. Within just a few hours of administering naloxone to an overdose patient, they may experience intense opioid withdrawal symptoms like nausea, diarrhea, cold sweats, body aches, and intense feelings of depression and anxiety. This overwhelming and oftentimes unbearable experience can lead many patients right back to where they started; using opioids to lessen their suffering, putting them at risk of yet another overdose.
With this reality in mind, it appears that naloxone is not truly a lifesaver, but perhaps just a life extender. This doesn’t have to be the case. The potentially deadly cycle of relapse after overdose can be greatly mitigated by administering buprenorphine – one of three types of drugs commonly used in medication-assisted treatment for opioid use disorder.
Buprenorphrine medications like Suboxone and Subutex were approved by the FDA in 2002 and are intended to help wean patients off opioid use and lessen withdrawal symptoms. These drugs work by binding to opioid receptors in the brain and minimizing unmanageable symptoms of withdrawal.
Because buprenorphine’s effects on pleasure, respiration and pain are mild, the risk of dependence is much lower than with high-dose opioids. An equally important benefit is that buprenorphine blocks other opioids from binding to receptors in the brain and, in doing so, discourages further drug use. Buprenorphine can make possible a gradual transition away from addiction, and paramedics can play a vital part in providing it to patients who refuse transport and express a willingness to kick the opioid habit.
In some parts of the country, pairing buprenorphine with naloxone for opioid overdose is already gaining support. This summer, the health commissioner of New Jersey authorized paramedics to carry and administer buprenorphine, which they’re encouraged to do after reviving an overdose patient with naloxone.
Of course, there are some that feel slightly dubious about the safety of buprenorphine. While it’s considered safer than other opioid addiction treatment drugs, like methadone, dispensing buprenorphine to patients creates the potential for misuse. But the reason behind that misuse may surprise you. A report from the U.S. Drug Enforcement Administration, released in 2016, found that most misuse is linked to, “the failure to access legitimate addiction treatment.” The report noted this gap could be improved by “increasing, not limiting, buprenorphine treatment.” As it turns out, the biggest danger associated with using buprenorphine is simply not following up with additional, formal addiction treatment.
Making addiction recovery possible through a dual approach
As the DEA report proved, we must look far beyond initial treatment techniques to truly change the narrative of the opioid crisis. A dual approach called medication-assisted treatment (MAT) continues to prove itself to be the most effective way to help patients overcome opioid addiction. By leveraging both medications (like naloxone and buprenorphine) and behavioral therapies, MAT attacks addiction from all sides. The former addresses cravings and withdrawal symptoms, while therapy and counseling give patients the mental and emotional guidance needed to prevent relapse.
But of course, a long-term treatment plan to seek counseling and professional help is only possible if overdose patients are supported in making it that far. In this way, naloxone and buprenorphine open the door to the treatment that’s imperative to lifelong recovery. Clinical research supports that idea: A 2015 study on emergency department-initiated buprenorphine and naloxone treatment found that, compared with other intervention methods, “ED-initiated buprenorphine ... significantly increased engagement in formal addiction treatment.”
Medical professionals should note that, in addition to ED-initiated buprenorphine, overdose patients in this study also received an appointment in the hospital’s primary care center. This followthrough with a doctor to help build a forward-looking treatment plan is just as important as the drugs used to revive a patient and should be a mandatory “part two” to initial medical treatment and buprenorphine maintenance.
Paramedics are almost always the first point of contact with overdose patients, and they have the power to change those patients’ lives for the better. Not only can they prevent death from the moment they arrive by administering naloxone and stabilizing the patient, they can also open the door to long-term recovery and help break the opioid addiction cycle with buprenorphine. Every time a patient is revived, we give them a chance to seek treatment, and oftentimes, the traumatic experience of overdose is the impetus that motivates them to find professional help. Every piece of the overdose and addiction treatment puzzle is crucial, and paramedics can be the first to lay the groundwork.
About the author
Ryan Kelley, NREMT, is a nationally registered emergency medical technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). In his current capacity as medical editor for American Addiction Centers, Ryan works to provide accurate, authoritative information to those seeking help for substance abuse and behavioral health issues.