Opioid overdose deaths in Chicago have skyrocketed since the start of the pandemic.1 Medication-assisted recovery (MAR) uses medication to help people with Opioid Use Disorder (OUD) decrease their reliance on powerful opioids like fentanyl and heroin. Among the most promising medications used for MAR is buprenorphine which diminishes withdrawal symptoms and cravings. When used under the supervision of a medical professional, buprenorphine can help patients initiate and remain active in treatment programs, significantly reduce the risk of overdose, and reduce the spread of communicable diseases.
Given strict state and federal regulation, many people with OUD do not have access to this potentially life-saving treatment. EMS paramedics who administer naloxone (known as a “reversal”) to individuals who overdose are currently unable to administer or prescribe buprenorphine treatment. This leads to an immense challenge for patients who begin to experience withdrawal symptoms almost immediately after the reversal. The pain associated with withdrawals causes many to come out of the reversal once again seeking opioids. Proactive and timely buprenorphine treatment would help break this cycle of substance misuse and overdose.
Borrowing from a promising model in New Jersey,2 EMS-administered buprenorphine treatment would enable specially trained paramedics to offer patients a starter dose of buprenorphine immediately after an overdose reversal. Once the patient regains awareness, EMS would conduct a motivational interview and assess the patient’s medical history and symptoms against a specialized protocol to be developed by CDPH. If the patient consents, paramedics would contact a waivered physician3 for authorization to administer a first dose on the spot.
Additionally, if the patient consents to be contacted after discharge, the EMS team can provide a warm hand-off to wraparound services and/or a formal MAR provider. As an alternative to placing the burden of navigating a complicated health bureaucracy (finding a provider, ID requirements, insurance paperwork, and strict schedules) onto patients, this model simplifies access to MAR and provides a compassionate avenue for treatment.
Notably, this model requires a change in state-level regulation through the Illinois Department of Public Health. A key step to implementation, therefore, is advocacy from IGA and CDPH. Given the statewide rise in overdoses, the promise of the New Jersey model, and recent changes in federal regulation, we anticipate that the state would be open to negotiating such a policy change.
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