From Revival To Recovery: Some Paramedics Are Changing The Front Line Of Addiction Care

By Rachel Crumpler

A life mislaid successful Buncombe County successful 2022 still weighs connected — and motivates — Shuchin Shukla, a family expert who specializes successful addiction medicine. 

A organization paramedic had responded to an overdose involving a personification precocious released from jail. After reviving them, nan paramedic told nan diligent astir a soon-to-launch programme that would commencement group connected a medicine utilized to dainty opioid addiction aft an overdose. 

“That would beryllium astonishing if you had it now, I would for illustration to commencement now,” nan diligent said, according to a displacement statement of nan encounter. 

But nan programme was still 10 days from launch. 

Soon after, nan personification utilized again, knowledgeable a 2nd overdose and went into cardiac arrest. They later died astatine nan hospital.

“For nan squad moving connected this, nan lawsuit deed location that each infinitesimal of each time matters for patients. At immoderate minute, they’re astatine consequence of dying aliases having an overdose,” Shukla said. “That’s really captious this is.”

For months, Shukla had been moving pinch Buncombe County Emergency Medical Services to motorboat Buncombe Bridge to Care, a task to equip paramedics to administer buprenorphine — a medicine proven to easiness opioid withdrawal symptoms, trim cravings and support semipermanent betterment for group pinch opioid usage upset — when responding to overdoses aliases others successful nan organization struggling pinch addiction.

Since March 2022, Buncombe County EMS organization paramedics person been capable to administer buprenorphine curen connected nan spot successful what Shukla said tin beryllium a “lifesaving ft successful nan door.”

Suboxone is simply a operation medicine that contains buprenorphine and naloxone. Medications for illustration this that trim opioid craving are often portion of nan rehabilitation process of group seeking betterment from constituent usage disorders. Photo credit: Liora Engel-Smith/NC Health News

Buprenorphine is 1 of three medications approved by nan U.S. Food and Drug Administration to dainty opioid usage disorder. It’s considered champion believe for curen erstwhile paired pinch counseling. As a longtime prescriber of these medications, Shukla knew their effectiveness firsthand. Yet only an estimated 1 successful 5 group who request them person them, according to authorities statistics. They are hindered by barriers for illustration a deficiency of entree to aesculapian providers and proscription and by fleeting information to activity treatment.

Many group who past an overdose diminution to beryllium taken to nan hospital, which leaves EMS unit arsenic their only constituent of interaction pinch nan wellness attraction system. Those interactions tin beryllium a captious window: Research shows group who past an overdose are astatine heightened consequence of consequent overdoses.

Overdose deaths for illustration nan 1 supra person led Shukla and others to spot EMS arsenic a important nexus that tin bring addiction curen straight — and instantly — to group successful crisis. A dose of buprenorphine tin trim nan consequence of different overdose for up to 24 hours.

Buncombe is among 30 EMS agencies successful North Carolina approved by nan authorities Office of Emergency Medical Services to administer buprenorphine for up to 7 days to negociate withdrawal and support early betterment arsenic a span to a semipermanent curen provider, according to a spokesperson astatine nan N.C. Department of Health and Human Services.

“I spot it gaining moreover much traction moving forward,” said Mike Campbell, training section chief at Stanly County Emergency Medical Services, 1 of nan first agencies successful nan authorities to statesman field-based buprenorphine successful 2019. “I think, earlier excessively long, it will go nan norm.” 

An emerging practice

EMS-provided buprenorphine is an emerging practice successful North Carolina — and crossed nan state — aimed astatine reducing opioid overdose deaths and expanding curen engagement.

Naloxone (brand sanction Narcan) is utilized to reverse nan effects of an opioid overdose. The supplier tin beryllium fixed arsenic a nasal spray, arsenic pictured, aliases an injection. Credit: Rachel Crumpler / NC Health News

Traditionally, paramedics’ activity ended erstwhile they administered naloxone, reversed nan overdose and offered carrier to nan hospital. But arsenic overdose calls surged, EMS crews often responded to nan aforesaid group again and again. Naloxone, the fast-acting opioid overdose reversal medication (brand sanction Narcan), tin cause unpleasant withdrawal symptoms, and that pushes galore group to usage again soon aft being revived. 

It was discouraging. 

“A batch of medics would reverse group complete and complete again until they yet saw them die, and that conscionable really burned retired a batch of our medics,” James “Tripp” Winslow, aesculapian head of nan authorities Office of Emergency Medical Services, said astatine nan Opioid Overdose Response Teams: Best Practices Summit successful Asheville earlier this month. 

That shape prompted immoderate EMS leaders to see really to amended service overdosing patients. Their answer: grow nan toolkit. They saw an opportunity to spell beyond reviving people to helping commencement them connected a way to betterment by administering buprenorphine successful nan field.

In 2024, EMS agencies crossed North Carolina responded to 25,389 suspected overdoses, according to information provided to NC Health News by nan authorities Department of Health and Human Services. As of Oct. 17, North Carolina EMS agencies person responded to 17,901 specified calls successful 2025 truthful far.

“I deliberation we’re nan correct group to initiate [buprenorphine] astatine nan correct time,” said Campbell from Stanly County. “If not, they whitethorn ne'er make it to nan clinic, whether they determine and alteration their mind and don’t want to spell into curen aliases ultimately, unfortunately, walk distant from a fatal overdose.”

“I position medication-assisted therapy arsenic a lifesaving intervention,” he continued. “Without it, we’ve seen what nan different extremity is: We suffer lives.” 

It’s a capacity that complements a growing number of post-overdose consequence teams — many based wrong EMS agencies — that are connecting group who struggle pinch addiction to ongoing betterment support, harm simplification resources and treatment. 

Shukla said it doesn’t return agelong for paramedics to get comfortable screening patients and administering a dose of buprenorphine erstwhile it’s appropriate. 

“Paramedics are realizing this is not a vulnerable med,” Shukla said. “It useful truthful well, and I deliberation much cities and counties will clasp it.”

Bringing addiction curen to nan beforehand lines

For Stanly County EMS, buprenorphine successful nan section has go a cardinal instrumentality successful responding to opioid-related calls, said Campbell, nan agency’s training section chief.

Not everyone accepts nan medicine instantly aft an overdose, he said, but for those who do, it tin quickly easiness withdrawal symptoms and stabilize them agelong capable to link pinch care. 

Others whitethorn determine to commencement later, often aft talking pinch adjacent support specialists who person their ain betterment experiences.

When they do, paramedics are ready.

“We are disposable to patients astatine 2 o’clock successful nan greeting if that’s erstwhile they determine that they want to participate recovery,” Campbell said, noting that organization paramedics successful nan region are disposable 24 hours a day. “That model is very, very small.”

He knows from individual experience.

“I’ve seen it pinch my ain sister — she’s fresh to spell to detox, and by clip she gets to detox, she’s changed her mind,” he said. “One of nan astir important parts is being capable to respond instantly astatine nan clip of request aliases nan clip of situation to get them connected astatine that very moment.” 

Shukla, who has led aggregate training sessions this twelvemonth connected post-overdose consequence teams and EMS-provided buprenorphine crossed nan state, said that field-based buprenorphine helps break down cardinal barriers to curen — constricted session hours, deficiency of proscription and security — making it easier for group to return that first measurement of starting medications for opioid usage disorder.

“Overdose survivors are astatine nan highest consequence of dying today, tomorrow and nan adjacent day,” Shukla said. “The mobility is: How tin we get to those folks nan fastest? How tin we get to them nan astir effective way?”

Making medications for opioid usage upset much accessible is simply a statewide goal, and paramedics are progressively a captious constituent of access.

A span to longer-term treatment

The up to 7 days of buprenorphine that paramedics tin typically provide, circling backmost to nan personification regular to administer doses, are not replacing clinics. They’re bridging nan spread until that personification is connected to a longer-term curen provider. Referrals travel from probation officers, hospitals and family members who person a loved 1 struggling pinch addiction, not conscionable overdoses.

That span is particularly useful successful agrarian areas pinch fewer prescribers.

Dalton Barrett (left), a organization paramedic successful Edgecombe County managing nan county’s post-overdose consequence team, which launched successful May 2023. He besides has been trained to surface and initiate group connected buprenorphine. Credit: Courtesy of Dalton Barrett

Edgecombe County, which has astir 50,000 people, has only 1 doctor’s agency that prescribes medications for opioid usage disorder, said organization paramedic Dalton Barrett, who besides leads that county’s post-overdose consequence team. Providing buprenorphine has been a game-changer since they started nan believe location successful 2023. 

“We knew that location were a batch of group retired successful nan organization that had nary thought astir medication-assisted treatment,” Barrett said. “The thought was to get personification ‘boots connected nan ground,’ to spell retired to nan organization to amended group … earlier an overdose, aft an overdose, during an overdose arena … to show them benignant of what nan options were and beryllium capable to supply it.”

Barrett said he’s dosed patients successful a scope of settings — including nan parking batch extracurricular a person’s occupation — taking curen straight to personification who had overdosed aggregate times. 

“It’s important that nan diligent doesn’t spell into withdrawal earlier they get to their appointment, because if they do, past their likelihood of going to that assignment is astir apt going to beryllium beautiful low,” Barrett said. “We want to make judge that they’re arsenic unchangeable arsenic imaginable earlier they get successful beforehand of that provider.”

So acold this year, Barrett and different organization paramedic person initiated 76 patients connected buprenorphine — up from 22 patients served successful 2023 and 67 patients successful 2024. 

Barrett and different paramedics astatine EMS agencies crossed nan authorities tin besides connection alternate destination transport, wherever they tin return personification to their first assignment pinch an addiction curen provider.

For EMS-provided buprenorphine to succeed, communities must person those curen providers successful spot for follow-up attraction — which is simply a situation successful immoderate areas.

“There’s tons of counties wherever there’s really nary options for outpatient-based opioid treatment,” said Winslow, nan aesculapian head of nan authorities Office of Emergency Medical Services, at a caller convention describing nan authorities of EMS medication-assisted curen span programs. “If they can’t get an action for outpatient-based opioid treatment, EMS and nan organization paramedics really can’t transportation that programme on. They can’t support pursuing those up.”

From caller believe to modular of care

EMS teams providing buprenorphine is still a comparatively caller practice, truthful nan investigation is still developing.

But early findings successful North Carolina and elsewhere show immoderate promise. 

Paramedics are progressively being seen arsenic a important nexus that tin bring addiction curen straight — and instantly — to group successful crisis. Credit: Vibhav Nandagiri / NC Health News

In New Jersey, nan first authorities to authorize paramedics to administer buprenorphine astatine nan segment of an overdose successful 2019, patients who received buprenorphine aft naloxone were astir six times much apt to person engaged pinch curen wrong 30 days, according to a 2023 study published successful nan Annals of Emergency Medicine. However, nan study did not find that group who took buprenorphine from EMS were little apt to overdose again compared pinch patients who didn’t person nan addiction medication.

In Wake County, a 2025 study published successful Prehospital Emergency Care reviewing nan first twelvemonth of paramedics administering buprenorphine recovered that 92 percent of screened patients who met nan eligibility criteria for buprenorphine accepted it. Nearly half of patients who received buprenorphine followed up pinch nan nonprofit outpatient curen supplier SouthLight. One successful 10 patients who received buprenorphine from EMS remained successful curen astatine nan extremity of nan yearlong reappraisal play successful July 2024.

Similarly, Buncombe’s first twelvemonth results, published successful a 2024 study successful nan Journal of Substance Use and Addiction Treatment, showed that paramedics started 118 patients connected buprenorphine, and 104 of them followed up astatine a session for continued care. More than two-thirds remained engaged successful curen aft 30 days.

Now, Buncombe paramedics are moreover busier, starting astir 30 to 40 patients connected buprenorphine conscionable successful nan past month, said Brandi Hayes, Buncombe’s post-overdose consequence squad adjacent support master coordinator, astatine an overdose acme earlier this month.

“More group are getting entree to care,” said Hayes, who helps patients modulation from receiving buprenorphine from paramedics to seeing outpatient curen providers. 

While information connected nan effectiveness of EMS-initiated buprenorphine is still emerging, nan grounds down buprenorphine itself is already clear. 

“The subject is truthful powerful astatine really lifesaving it is, peculiarly for high-risk groups for illustration group leaving jails and prisons aliases group surviving a nonfatal overdose,” Shukla said.

His dream is that EMS offering buprenorphine aft an overdose — aliases to those pinch ongoing opioid usage issues — will go arsenic regular arsenic giving aspirin for thorax pain.

“Buprenorphine saves overmuch much lives than aspirin ever will,” Shukla said. “It’s truthful overmuch much effective, and yet it’s truthful acold distant from being seen arsenic that basal of a consequence to nan business of overdose aliases ongoing opioid use. That’s wherever we request to beryllium arsenic a society.”

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