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Wis. FD medics now carrying buprenorphine

Madison Fire Department paramedics will now be able to administer buprenorphine

By David Wahlberg
The Wisconsin State Journal

MADISON, Wis. — Starting Friday, paramedics with the Madison Fire Department will carry another tool to curb opioid addiction: buprenorphine, a drug used to treat opioid use disorder.

Paramedics have long used naloxone, or Narcan, to reverse opioid overdoses in people experiencing them. A few years ago, agencies such as Fitch-Rona EMS southwest of Madison started giving kits containing naloxone to patients or families who might later need them.

Now, the Madison Fire Department will administer an initial dose or two of buprenorphine to people having withdrawal symptoms of opioid addiction, including those who just overdosed and received naloxone. Then paramedics will try to connect the people to ongoing outpatient treatment and other services.

Buprenorphine, an ingredient in Suboxone, is one of three medications approved for treating opioid addiction. A synthetic opioid, it can reduce cravings and ease or prevent withdrawal symptoms, such as anxiety, muscle aches and sweating. The Madison agency will use a pill form that dissolves under the tongue.

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“The goal of the program is to provide the patient with that initial relief, or improvement in their symptoms, hoping that they will then go to the emergency department with our paramedics to receive a prescription for the medication that they can pick up at any pharmacy,” said Dr. Megan Gussick, medical director of Madison Fire Department.

“The hope is that this is a bridge to ongoing treatment ... that will hopefully prevent them from having that fatal overdose,” Gussick said.

The West Bend Fire Department started carrying buprenorphine in July. Greenfield and the city of Milwaukee have followed suit, Dan Pojar, EMS director for Milwaukee County, said Thursday.

The Madison Fire Department will be the fourth agency in the state to start the program, equipping ambulances, community paramedics and CARES teams with the drug, Gussick said. Community paramedics make home visits to people with complex needs to help prevent unnecessary 911 calls. CARES, or community alternative response emergency services, sends crisis workers instead of law enforcement to mental health emergencies.

Wisconsin had 1,461 opioid overdose deaths in 2022, topping the previous record of 1,427 in 2021. Dane County had 126 opioid overdose deaths in 2022, down from its record of 139 the year before.

In nearly half of fatal overdoses in Dane County, the people who died had an emergency room visit within the past year, according to a review of overdoses in 2022. A third of the time, they had a recent encounter with emergency medical services.

The Madison Fire Department’s program to carry buprenorphine is part of a move to address opioid addiction in “pre-hospital” settings, the department said. The agency said it is also encouraging hospitals to offer buprenorphine in the ER to patients who need it.

Other medications approved to treat opioid use disorder include methadone, also a synthetic opioid that can reduce cravings and prevent withdrawal. Naltrexone, or Vivitrol, an injection taken every four weeks, blocks the effects of opioids in the body.

Use of the drugs, in what is called medication-assisted treatment for addiction, is one of the main ways Wisconsin is spending nearly $40 million it has received in opioid settlement funds or is expected to receive this year. Overall, the state is expected to get more than $740 million by 2038.

Madison has seen some changes in its addiction clinics recently. Monarch Health, which opened in Downtown Madison in September 2020 , closed in May.

In June, Arizona-based Community Medical Services, or CMS, opened on East Broadway, north of the Beltline and east of Highway 51. It’s one of 28 methadone clinics, or opioid treatment programs, in Wisconsin and among five in Madison. Like the others, it also offers buprenorphine and naltrexone.

Other addiction services providers include NewStart, UnityPoint Health-Meriter’s addiction treatment program in Madison, and Tellurian Behavioral Health in Monona.

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