Extended-Release Buprenorphine Administration by Emergency Medical Services Paramedics: A Case Series

Medications for opioid use disorder (MOUD), including buprenorphine, reduce mortality and improve treatment retention. However, daily sublingual formulations may be impractical for patients with unstable housing, limited healthcare access, or interrupted care. Extended-release buprenorphine (XR-BUP) provides sustained therapeutic levels without daily dosing and may overcome barriers to adherence. Emergency Medical Services (EMS), both 911 and Mobile Integrated Healthcare (MIH) models, are uniquely positioned to initiate or maintain MOUD among high-risk individuals in community settings. The purpose of this case series is to describe EMS clinicians administering XR-BUP to individuals with opioid use disorder (OUD) in a 911-based system.

We report three cases of paramedic initiated XR-BUP administration in a 911-based EMS system in Southern New Jersey between July and September 2025. Patients were selected based on OUD severity, EMS utilization, and inability to access consistent outpatient treatment. EMS paramedics initiated and administered XR-BUP via physician-directed protocols. Patients were followed longitudinally after EMS administered XR-BUP.

EMS successfully administered XR-BUP in all three cases without precipitated withdrawal or adverse events. All patients demonstrated improved engagement with addiction care. EMS treatment enabled continuity of treatment and bridged treatment gaps in traditional healthcare access.

EMS-facilitated XR-BUP administration is feasible and may represent an innovative strategy to initiate and sustain MOUD among high-risk populations. EMS systems, both 911 and MIH, may serve as effective platforms for delivering long-acting buprenorphine and improving treatment access and adherence. Further research is needed to evaluate safety, scalability, and long-term outcomes.