Buprenorphine Field Initiation of Rescue Treatment (Bupe FIRST)

In June of 2019, the New Jersey State Health Commissioner signed an executive directive allowing the medical directors of the state’s Mobile Intensive Care Unit (MICU) programs to authorize paramedics to carry and administer buprenorphine to treat acute withdrawal symptoms after having had an opioid overdose reversed with naloxone. The directive simply added buprenorphine to the list of medications available to paramedics in the MICUs and required officials in each county to train paramedics on the protocol.

Cooper University Health Care in Camden, NJ had already been offering buprenorphine to individuals who were brought into the emergency department (ED) after having experienced an overdose that was reversed. However, paramedics stated that only about 50 percent of the individuals who have had an overdose reversed agree to be sent to the ED. Because of this, doctors and other substance use disorder specialists determined that offering buprenorphine on the street made sense. If a person accepts the medication, the paramedics stay with him or her until the medication takes effect, relieving some of the painful withdrawal symptoms. The paramedics then refer the individual to treatment.

A September 2022 study in the Annals of Emergency Medicine entitled, “Impact of Administering Buprenorphine to Overdose Survivors Using Emergency Medical Services,” found that providing immediate access to buprenorphine results in a six-fold increase in engaging the overdose victim in treatment. It also determined that “[p]atients who encountered paramedics trained to administer buprenorphine and able to arrange prompt substance use disorder treatment after an acute opioid overdose, demonstrated a decrease in opioid withdrawal symptoms [and] an increase in outpatient addiction follow-up care.” However, there was no decrease in repeat overdoses. The study concluded that paramedics providing rapid access to buprenorphine was a promising model to address opioid use disorder.

Almost five years after the start of the program, overdose victims in Camden County are not only getting drug treatment but also help with housing, employment, and other important ancillary services. Other jurisdictions throughout the nation have begun to replicate this program.

For the first time in three years, Camden County overdose deaths decreased in 2023.