New Jersey’s 21 mobile intensive-care paramedic units are now authorized to administer the drug buprenorphine to patients almost immediately after reviving them from an opioid overdose.
The order, from Dr. Shereef Elnahal, New Jersey’s health commissioner, authorizes them to carry Suboxone or a generic equivalent.
As one of just three medications approved to treat opioid use disorder, buprenorphine has become a centerpiece of addiction treatment efforts nationwide.
While the medication is shown to be highly effective in reducing overdose deaths and illicit drug use, it is an opioid and is therefore regulated as a Schedule III substance by the Drug Enforcement Administration.
As a safeguard, New Jersey’s 1,900 paramedics will need to obtain permission from the emergency physician overseeing their unit before administering buprenorphine when responding to an overdose call. The supervising physician must have a DEA waiver to prescribe buprenorphine, a spokeswoman said.
While the announcement came as a surprise to many addiction experts, most applauded the effort. But obtaining permission from individuals experiencing withdrawal pain — some in a state of semi-consciousness — to administer buprenorphine could prove challenging, said James Langabeer, an addiction medicine researcher.
“These are not conversations that are easy to have for anybody, and especially for a paramedic,” Langabeer says, noting the short window between responding to a 911 call and a hospital drop-off. “There’s a whole set of decision-making processes that the paramedic will have to integrate into their protocol.”
It is also unclear whether cost will prove an obstacle to patients beginning treatment. While buprenorphine is generally inexpensive, New Jersey’s health department said in its release that patients given buprenorphine would be billed according to their insurance, in the same manner as patients are billed when paramedics administer drugs to treat asthma attacks or insulin shock.
Most importantly, Langabeer said, the new program will only prove effective in stemming overdose deaths if patients are connected to longer-term treatment almost immediately. “It’s a really positive first step — but the next step is the next day. They’ve got to be linked to continuing treatment.”
“Here we are basically suggesting that we’re going to treat the person in as well-meaning and patient-centric a manner as possible,” said Dr. Dan Ciccarone, a professor who studies heroin use and the opioid epidemic. “It’s very interesting — a potentially brilliant idea.”