This is a first for the addiction treatment world. Last month, the New Jersey health commissioner authorized its paramedics to administer the drug buprenorphine (brand name Suboxone) to patients after their overdose had been reversed using the opioid antidote naloxone. This groundbreaking model has two specific goals. The first goal is treating opioid withdrawal symptoms caused by the administration of naloxone. Naloxone (also known as Narcan) is an “opioid antagonist” that reverses the life-threatening effects of opioids – specifically depression of the central nervous system and respiratory system. Simply put, naloxone helps to stimulate an overdose victim’s breathing and support improved blood pressure.
While its life-saving results are celebrated at the moment, naloxone can put an overdose victim into a state of immediate withdrawal. Despite suffering a near-death experience only moments before, if an overdose victim is unable to enter a treatment program, the pain and agony of opioid withdrawal pushes them right back into active addiction. By administering Suboxone after naloxone, the withdrawal symptoms are kept at bay.
The second goal is an immediate transition into long-term treatment. Naloxone removes the fog of opioids and offers a sense of clarity, if only for a short time. By administering Suboxone after naloxone, this sense of clarity is extended, providing a “softer landing” for someone recovering from an overdose. With Suboxone onboard, New Jersey officials believe it’s more likely an overdose victim will choose to enter addiction treatment.
No other state in the country offers this kind of on-scene treatment, and most addiction experts support New Jersey’s “out of the box” thinking.
Combining Naloxone and Suboxone
“This comes out of left field, and it’s very interesting,” said Dr. Dan Ciccarone, a University of California, San Francisco, professor who has extensively studied the opioid epidemic.
“It’s a potentially brilliant idea.”
Suboxone is one of only three medications approved by the FDA for treating opioid addiction. It has shown time and time again to be highly effective in reducing illicit opioid use and overdose deaths.
To prescribe Suboxone, licensed clinicians have to take specialized training courses. That’s what makes New Jersey’s decision even more impactful – they’re investing in saving more lives by ensuring certified paramedics can administer Suboxone on the scene of every opioid overdose.
“Here we are suggesting that we’re going to treat the person in as well-meaning and patient-centric a manner as possible,” Ciccarone said. “And that means naloxone plus a softer landing with buprenorphine.
Equipping Paramedics to Administer Suboxone
There are already several emergency room doctors prescribing Suboxone to patients after an overdose. However, allowing paramedics to administer the medication post-overdose takes New Jersey into uncharted territory.
For safety purposes, when responding to an overdose call, each of New Jersey’s 1,900 paramedics will need to obtain permission from an emergency physician before administering Suboxone. The supervising physician must have a DEA waiver that allows him or her to prescribe Suboxone. Only the state’s mobile intensive care units are authorized to carry Suboxone or a generic equivalent.
“Buprenorphine is a critical medication that doesn’t just bring folks into recovery; it can also dampen the devastating effects of opioid withdrawal,” Dr. Shereef Elnahal, New Jersey’s health commissioner, said in a statement. “That’s why equipping our EMS professionals with this drug is so important.”
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