Opioid use disorder is considered a chronic and life-threatening condition that affects at least 2.5 million people in the United. States. To reduce opioid overdose deaths and begin a bridge to treatment among people with opioid overdose disorder, the Medical Director of Emergency Services of Forsyth County, North Carolina has just signed a protocol allowing specially trained community paramedics to administer buprenorphine for up to seven days as a bridge to Medication Assisted Treatment (MAT). The paramedics will offer this medication to opioid overdose survivors (OOS) beginning immediately following reversal, and without requiring transport to an emergency department. This cutting edge and innovative preventive intervention is intended to meet OOS where they are by providing an initial dose of buprenorphine for withdrawal relief and support for MAT initiation. At present, we do not know whether OOS are willing to begin this regimen at this vulnerable time. Our study?s purpose is to examine the extent to which OOS consent to accept paramedic-prescribed buprenorphine administered immediately following reversal. We will also examine whether the presence of a community- based peer navigator at the scene of an overdose reversal, in addition to a paramedic, increases OOS? acceptance of buprenorphine. The peer navigator?s role will be to provide support, encouragement, and education concerning the benefits of buprenorphine as a bridge to MAT. Our study will clarify whether a buprenorphine regimen as a bridge to MAT can successfully be introduced immediately following a reversal, or whether the invitation should be delayed, as some believe, until a later time. We will also investigate the added value of peer navigators as a means to encourage OOS to begin buprenorphine, as well as OOS? characteristics associated with the acceptance or refusal of the medication. We will analyze community paramedic data collected at the time of reversal to calculate the proportion of persons who accept buprenorphine and whether acceptance rates vary by the presence of a peer navigator. This observational study is time-sensitive as the findings of this unique opportunity will yield invaluable information concerning this novel strategy to prevent opioid overdoses and facilitate OOS? entry into MAT.

Public Health Relevance

At present, we do not know whether opioid overdose survivors are willing to begin a buprenorphine regimen immediately following an overdose reversal. Our study?s purpose is to examine the extent to which survivors consent to accept paramedic-prescribed buprenorphine on-scene and whether this is affected by the presence of a community-based peer navigator. Knowledge gained from this study will be critical to understanding whether the availability of buprenorphine on-scene is a viable and effective method to administer the drug.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZDA1)
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Zur, Julia Beth
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Pacific Institute for Research and Evaluation
United States
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