Lessons Learned from the Implementation of the Wake County, North Carolina EMS Medication for Opioid Use Disorder Program

Objectives: Buprenorphine has recently emerged as a prehospital treatment for opioid use disorder. Limited data exist regarding the implementation of prehospital buprenorphine programs. Our objective was to describe the development, deployment, lessons learned, and ongoing evolution of the Wake County EMS buprenorphine program using data from the first year following implementation.

Methods: We developed a protocol to provide buprenorphine in the prehospital setting to patients who 1) suffered an opioid overdose with reversal using naloxone, or 2) experienced withdrawal symptoms at least 72 hours after last opioid use. Measures included encounters with screening for buprenorphine induction, successful inductions with buprenorphine, successful follow up with outpatient treatment, and successful continued outpatient treatment. For the period 7/5/2023 - 7/4/2024, we report descriptive statistics.

Results: We identified 1,378 encounters for adult patients who received naloxone, of which 953 had documentation of opioid overdose as the primary impression. During the same timeframe, 342 encounters included screening for prehospital buprenorphine induction. Of encounters with screened patients, 66 (19.3%) encounters were eligible for buprenorphine induction and of these, 61 encounters (92.4%) resulted in buprenorphine induction. Of encounters with induction, 29 (47.5%) resulted in successful follow up with our outpatient provider, and 7 (11.4%) remained in treatment at the end of the review period.

Conclusions: Our prehospital buprenorphine induction program successfully inducted eligible patients and connected them with follow up. Almost half of inducted patients were able to follow up with our outpatient provider. One in ten patients who received buprenorphine from EMS remained in treatment. There exists an opportunity for EMS to screen more patients for buprenorphine induction as only one in four patients who received naloxone were screened for buprenorphine induction. Lessons learned include the need for recurrent EMS clinician education regarding buprenorphine screening, the need for a "buprenorphine champion" to follow up with inducted patients and addressing early administrative and technological barriers to ensure data exchange.