Buprenorphine on Board: Emergency Medical Services-Initiated Buprenorphine Treatment

Emergency Medical Services (EMS) is often the first point of contact for individuals with opioid use disorder (OUD), however many people decline transport or leave the emergency department (ED) early, resulting in missed opportunities for engagement in lifesaving addiction treatment. To address this gap, EMS agencies have begun offering buprenorphine for opioid withdrawal after naloxone reversal or abstinence. Experiences and perspectives of paramedics regarding buprenorphine are unknown. In preparation for a NIDA Clinical Trials Network study about EMS-initiated buprenorphine, we conducted focus groups with EMS providers.

Three focus groups were conducted with paramedics and emergency medical technicians working in 3 EMS systems with established EMS buprenorphine programs: Camden County, NJ; Jersey City, NJ; Minneapolis, MN; and Alameda County, CA. Discussion questions were about experiences and perspectives providing prehospital buprenorphine for opioid withdrawal after opioid overdose reversal or opioid abstinence. Interviews were recorded, transcribed, and coded by a team of 3-4 coders with expertise in qualitative research, emergency medicine, EMS, and addiction medicine. All codes were agreed upon by consensus. Emergent themes were identified using thematic analysis.

There were 29 participants across 3 focus groups. All saw EMS-initiated buprenorphine as in the scope of EMS care. Key factors to improving EMS-initiated buprenorphine were addiction training, supportive clinical champions, and experience observing clinical improvement when patients received buprenorphine. Participants felt training gave them more confidence in their ability to care for patients with OUD, mitigated clinician burnout, and added a sense of purpose. Participants identified patient education, local drug supply concerns, addressing patients’ social needs, patient readiness for treatment, and building trust were crucial for patient uptake of buprenorphine.

Buprenorphine can be a key component of prehospital OUD care. Practice change was supported by clear training protocols and clinical champions. EMS-buprenorphine provided participants with relief from opioid epidemic-related caregiver fatigue, supporting renewed motivation to care for patients with OUD.