(16) Buprenorphine Pre-Hospital: A Review of 3 Years of MAT Induction by EMS

Buprenorphine Pre-Hospital: A review of 3 years of MAT Induction by EMS

Medication assisted therapy (MAT) induction with buprenorphine has become the gold standard of treatment in opiate use disorder secondary to its demonstrated abilities to significantly reduce harm, and save lives.

Pre-hospital clinicians are first contact healthcare professionals for many of these patients. Despite this, buprenorphine use by EMS is relatively rare. The goal of this study was to evaluate induction of MAT by a large urban fire based EMS system prior to referral to next level outpatient therapy.

Methods:
This retrospective study used the MAT PI Database. Inclusion criteria for the data base were all patients referred to MAT, referrals may come from EMS, public, or other public safety. Study dates were 01/2019 to 07/2021. Exclusion for the study included: children, prisoners, referral where no patient contact was able to be made, and patients lost to followup. Data elements included were: calculated opiate withdrawal score (COWS) before and after buprenorphine, and result of referral to next level care. Descriptive statistics were used.

Results:
A total of 263 patients were evaluated by EMS for MAT induction, and 99 patients met criteria and received at least one dose by EMS staff. There were no adverse events reported to either the EMS system, or the receiving addiction treatment facility related to dosing by EMS clinicians in the pre-hospital environment. Specifically, no events of respiratory depression, subsequent overdose, or need for naloxone administration were observed. Of the 99 patient’s dosed, a total of 568 8mg Buprenorphine doses were provided to patients by EMS clinicians during the study time period, based off of individual COWS based assessments.

Conclusions:
EMS based MAT was safe and well tolerated. Limitations included retrospective study design and patients that were evaluated by EMS staff for MAT induction, but were not found to be appropriate for dosing based off of their presenting COWS assessment.

References: “Prehospital Initiation of Buprenorphine Treatment for Opioid Use Disorder by Paramedics” - H Gene Hern, David Goldstein, M. Kalmin, S. Kidane, S. Shoptaw, Ori Tzvieli, and Andrew Herring