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

Area of Science:

• Emergency medicine
• Public health
• Pharmacology

Background:

• Buprenorphine is increasingly used for prehospital treatment of opioid use disorder (OUD).
• Limited data exist on the implementation and outcomes of prehospital buprenorphine programs.
• The Wake County EMS program was developed to address this gap.

Purpose of the Study:

• To describe the development and deployment of the Wake County EMS buprenorphine program.
• To evaluate the program's first-year outcomes, including patient screening, induction, and follow-up.
• To identify lessons learned for future prehospital OUD treatment initiatives.

Main Methods:

• A protocol was established for prehospital buprenorphine administration to patients with opioid overdose or severe withdrawal symptoms.
• Data were collected on patient encounters, buprenorphine screening, induction success, and outpatient treatment follow-up.
• Descriptive statistics were used to analyze data from the first year of program implementation (July 2023–July 2024).

Main Results:

• Out of 1,378 naloxone encounters, 342 patients were screened for buprenorphine induction.
• 66 patients were eligible, and 61 (92.4%) received prehospital buprenorphine.
• 29 patients (47.5%) successfully followed up with outpatient treatment, and 7 (11.4%) remained in treatment.

Conclusions:

• The prehospital buprenorphine program successfully inducted eligible patients and facilitated outpatient follow-up.
• Significant opportunities exist to increase patient screening rates within the EMS system.
• Key lessons include the need for ongoing clinician education, dedicated follow-up support, and streamlined data exchange.