Team of Ottawa paramedics using Suboxone to respond to overdose calls amid worsening toxic drug crisis

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A team of specially trained paramedics in Ottawa is trying a novel approach to treat opioid overdoses by bringing an additional medication to emergency calls.

Naloxone is widely used by family members, bystanders and health professionals to reverse opioid overdoses. But for all its life-saving benefits, the medication, which counters and blocks the effects of opioids, sends recipients into immediate withdrawal, causing severe side effects. This leaves patients in excruciating pain, unable to contemplate treatment options and prompting them to seek more drugs to ease their withdrawal symptoms.

Logan Martin, program lead of the mental well-being response team with the Ottawa Paramedic Service, is spearheading the new initiative, which launched in March, to train and equip a team of paramedics to give buprenorphine and naloxone, sold as one drug under the brand name Suboxone, after a person has been revived using just naloxone.

“Naloxone can literally save a life,” Ms. Martin said. “The challenge is after somebody receives it, the withdrawal symptoms are terrible. People say it’s the worst thing they’ve ever experienced. It feels like you are dying from it, withdrawal.”

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Adding the new medication will ease painful withdrawal symptoms and allow the patient to be more comfortable. “The humane thing to do is make someone feel better,” Ms. Martin said. “But also, when someone does feel better, they’re also going to be more open to discussing their options.”

Ms. Martin’s team is specially trained to answer calls related to mental health and unlike other paramedics, aren’t required to transport patients to the hospital. The team has established partnerships with local hospitals, including the Royal Ottawa Mental Health Centre, a major mental health institution, giving individuals who are revived after an overdose access to a follow-up assessment within a day. Ms. Martin has also forged a partnership with Ottawa Public Health to better connect people to wound care, harm-reduction supplies and other health services, including possible treatment options.

Buprenorphine has been used for years to treat addiction, but is usually administered in a single dose as part of organized outpatient treatment programs, which are inaccessible to many people for a variety of reasons, including lack of access to a primary care physician.

The drug is an opioid that blocks the effect of other opioids, meaning it’s harder to overdose while taking it, and it alleviates withdrawal symptoms and reduces cravings without producing euphoria.

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Nearly 6,000 people died as a result of opioid overdoses in Canada from January to September, 2023, some of the largest figures seen since data collection began in 2016, according to the Public Health Agency of Canada. Last July, the Ontario government made changes allowing paramedic services to use the buprenorphine and naloxone combination to revive people experiencing an overdose, and although the process to alter treatment protocols across jurisdictions can be slow, more health units are taking notice, said Ms. Martin.

She first heard about the protocol last spring from paramedics in Timmins, who had started using Suboxone on overdose emergency calls even before they received official approval from the province’s Health Ministry. The Cochrane district, which encompasses Timmins and the surrounding area, has one of the province’s highest overdose fatality rates and was the first jurisdiction in Canada to use Suboxone in this way. The Porcupine Health Unit, which serves Timmins and the surrounding area, had an overdose fatality rate of 56.6 per 100,000 in March, 2023, according to the latest available data from Public Health Ontario. The provincial overdose fatality rate was 19.5 per 100,000 in March, 2023.

“It’s extremely important to pursue it,” said Seamus Murphy, deputy chief of standards and community services with the Cochrane District Paramedic Service. “A life we save today can be a life changed tomorrow.”

Mr. Murphy’s niece died from an opioid overdose two years ago, an event that brought the toxic-drug crisis to the forefront of his mind and reinforced the idea more action needs to be taken. That’s why he and his team began administering Suboxone last year, even before they had the provincial authority to do so, Mr. Murphy said.

So far, he says, they’re seeing positive results. The Cochrane district, which has a population of around 78,000, responded to 231 overdose calls last year. Of those, 14 per cent of individuals died. Twelve per cent were given the buprenorphine and naloxone combination after being revived. Of those who received it, 11 per cent entered long-term treatment, a percentage that far outpaced expectations, Mr. Murphy said. (Not all patients receive Suboxone because they aren’t in severe withdrawal or don’t meet other clinical criteria.)

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Paramedics who work on Ms. Martin’s team have the flexibility to remain with patients for an extended period of time, during which they can counsel patients and provide them with referrals to community resources and health professionals.

And being able to avoid the emergency room prevents long, unnecessary waits and instead keeps the focus on connecting individuals with the appropriate mental health support quickly.

Mike Souilliere, director of patient care services with the substance use and concurrent disorders program with the Royal, said immediate access to a health care professional who specializes in addiction and treatment is vitally important.

“Having that information at the time of crisis can be the step that motivates them to get care,” he said. “There is stigma connected to substance use. A six- to eight-hour wait at the emergency room may be something that stops someone from taking the next step to care.”

Paxton Bach, co-medical director of the British Columbia Centre on Substance Use, said Suboxone is a “gold standard” treatment for opioid-use disorders and that allowing paramedics to dispense it could help respond to the overdose crisis.

Dr. Bach noted that people frequently interact with the health care system in the weeks and months before an opioid overdose death, suggesting that buprenorphine and naloxone could be used earlier in those settings to help prevent fatal outcomes. While it’s too early to say whether paramedic-led Suboxone programs will yield long-term benefits, he said he applauds the efforts of those working to expand access.

“It is important we proceed carefully and thoughtfully and make sure that we’re being appropriately cautious, but I think that it’s also a very low-risk medication,” Dr. Bach said.