Naloxone is a miracle cure for people who have overdosed from heroin or fentanyl, but it comes with a major downside. Though the drug can revive someone who has overdosed, that person often experiences severe opioid-withdrawal symptoms immediately after recovery.
“We had a lot of paramedics telling us that someone would be in an ambulance, knocked out, and then receive naloxone, and they would run out of the ambulance,” New Jersey’s health commissioner, Shereef Elnahal, told me. The pain of withdrawal can be so severe—like a very intense flu—that the person often feels an incredible urge to use drugs again.
New Jersey might have found a way around this problem. This week, Elnahal signed an executive directive that will allow paramedics to carry buprenorphine, a medication that treats opioid addiction, to help soften the withdrawal symptoms after someone has been revived with naloxone. Buprenorphine is considered one of the gold-standard drugs for the treatment of opioid addiction. If a person addicted to opioids continues to take it after a visit from paramedics, it could put them on the path to recovery.
The move appears, according to Stat News, to be the first attempt in the nation to initiate buprenorphine treatment for overdose victims immediately after revival. Last year, more than 3,000 people died of overdoses in New Jersey. To administer buprenorphine, which is sometimes known by the brand name Suboxone, paramedics will need to obtain permission from the ER doctors who oversee them. The patient’s insurance will then be billed for the provision of the buprenorphine.
Andrew Kolodny, a psychiatrist at Brandeis University who studies addiction, calls the move “a fantastic idea.” “We’ll need to track this closely because I don’t think it’s been done before,” he told me via email. “But it’s a very promising intervention that could become a new standard of care.”
Among the questions that will need to be tracked: What happens to patients who don’t have insurance? According to the Kaiser Family Foundation, 11 percent of adults ages 19 to 64 in New Jersey are uninsured. And how many of the overdose victims will be connected to longer-term treatment? According to Keith Humphreys, a professor of psychiatry at Stanford University, administering buprenorphine in overdose cases “will make a meaningful difference only if rescued individuals are linked immediately to ongoing treatment, and agree to participate in that treatment.”
Elnahal said the goal is to refer all the buprenorphine claims for uninsured patients to hospitals’ charity-care programs, which provide treatment for free or at reduced prices. The patients given buprenorphine will be transported to a hospital, where many ER doctors and addiction specialists are now licensed to prescribe buprenorphine long-term. Those who refuse transport will be given “educational materials” about treatment instead, a Department of Health spokeswoman told me via email.
Despite buprenorphine’s effectiveness, access to long-term treatment continues to be a challenge for opioid addicts nationwide. It’s difficult to find a primary-care doctor who is licensed to prescribe buprenorphine, which can take more than a year to work fully, largely because many doctors don’t really understand the medication. Though New Jersey has a higher-than-average number of doctors who have obtained the license required to prescribe buprenorphine, only one-quarter of all addiction-treatment providers in New Jersey offer medication-assisted treatment, a category that includes buprenorphine. According to Elnahal, the state is actively training more and more doctors in how to prescribe buprenorphine.
Now New Jersey’s addicts may get their first dose of buprenorphine from the hands of paramedics. But what happens to those individuals next will determine whether the state can really make a dent in its epidemic. Elnahal said that ideally, the federal requirement that doctors be licensed to prescribe buprenorphine would be eliminated entirely.
“To us, it doesn’t make sense that a physician would have to get a special certification to treat addiction when we can prescribe very high doses of opioids without a certification,” he said. “One is causing the epidemic, and the other is helping. It’s unfortunate that doctors have to go through these hoops.”