PITTSBURGH — Buprenorphine, a drug used to curb opioid addictions, can kickstart the road to lasting recovery — though getting it takes a prescription from a specially trained physician.
A pilot program unveiled in September by the Pittsburgh Bureau of EMS promises to change that, making buprenorphine available to opioid users at the scene of an overdose.
In an interview with a team of Pittsburgh EMS paramedics and crew chiefs who work on the frontlines of the region’s opioid crisis, reactions to the program — now in its third month — were positive.
“I think overall, we’re seeing a lot of good things right now,” said Nicholas Okwiya, a 24-year-old paramedic in the Pittsburgh Bureau of EMS. “(We have) the opportunity to administer something maybe a little bit more preventative, without necessarily requiring someone to seek immediate treatment at a hospital.”
Buprenorphone, also known as Suboxone, is technically an opioid itself, though less powerful than drugs like methadone or heroin. The FDA-approved drug can curb opioid withdrawal symptoms and cravings in users, and is meant to be used alongside professional recovery treatment.
“As soon as you administer the buprenorphine, if it works, their symptoms start to resolve, and it happens right in front of you,” said Simon Taxel, a 37-year-old crew chief from Brookline. “For me, that’s why I work in health care, is those moments when I can make a difference for a patient in a very tangible and immediate way.”
But getting buprenorphine means visiting a hospital, and Okwiya and other paramedics have lately noticed a decline in overdose patients wanting to visit a health care setting.
The reason, Taxel said, was that opioid users feel they are a stigmatized community in Pittsburgh, and are not treated well at times by hospital staff.
“They often feel marginalized, and feel like it’s a situation where they’re not going to be treated with the respect and compassion that they deserve, so they avoid it strenuously,” Taxel said.
Richard Jones, a 33-year-old Unit 3 paramedic agreed, and said his team recommends overdose patients go to the hospital for treatment that includes buprenorphine, but a level of distrust often prevents a visit.
“I can think of several hospitals where these patients just sit in the hallway bed for an hour or two hours to make sure their vitals remain stable,” Mr. Jones said. “Then out the door they go — still in withdrawal.”
Unit 3 is just one of several taking part in the pilot program, which lasts for one year. Units 2 and 8, which respond to areas like Knoxville and Beltzhoover, are also participating. According to Mark Pinchalk, assistant chief of EMS, these are Pittsburgh’s overdose hotspots.
The buprenorphine program hopefully will be expanded to other units as more patients take part, Pinchalk added.
It’s just the latest in a series of efforts, including a naloxone leave-behind program, the bureau has implemented since opioid overdoses began to spike in 2016.
Since the beginning of the COVID-19 pandemic, drug overdoses have increased in Pittsburgh.
In October 2020, the city of Pittsburgh recorded 67 overdose-related calls for EMS, many of them opioid related. But by this summer, overdose counts in the triple digits became common — 106 were made to EMS in July alone.
Because buprenorphine is prescribed by a specially trained physician, getting approval to equip paramedics with the drug required months of planning by the city.
According to Joshua Schneider, an overdose prevention coordinator in the Office of Community Health and Safety, his team presented their plan to the Pennsylvania Department of Health and an advisory board of paramedics for approval.
Schneider believes Pittsburgh is just the third area in the country to equip paramedics with buprenorphine, behind Camden, New Jersey, and Contra Costa County, California.
“We didn’t really find much resistance — people thought it was generally a good idea,” Schneider said. “There was a pretty big recognition that we need to do more, rather than just the band-aid solution that is naloxone.”
Nalaxone is a drug that reverses opioid overdoses, but is not used in long-term treatment.
Opioid users often experience overdoses in a cyclical nature, where paramedics treat the same patients with naloxone, only to return again for another call.
It’s a process Jones called “defeating” for a paramedic.
“After you’ve seen these people multiple times and you’ve given them the band-aid of just giving them naloxone and resuscitating them,” Mr. Jones said, “then you go back and this time, it was too late for them.”
That’s why Jones believes administering buprenorphine is a “huge tool” for paramedics.
“We can help get them directly linked to long term recovery,” he said. “Where hopefully we don’t have to deal with that again.”
Taxel said that actually getting opioid users to start on buprenorphine involves breaking down previous misconceptions, mainly that buprenorphine is no different than heroin found on the street.
“In treatment circles and treatment communities in the United States, medication assisted treatments are often looked down upon as just replacing one drug for another,” Taxel said. “The fact is, abstinence-only recovery treatment in fact increases the likelihood of the person relapsing and overdosing.”
The paramedics interviewed all felt they had learned more about treating addiction as the EMS department continues to deal with a flood of opioid overdoses.
“I’ve really come to the realization that addiction is not a moral failure and it is incredibly damaging for it to be described that way,” Taxel said.
“Everyone sitting here in this meeting is potentially one bad day away from being in a similar situation as anyone we might encounter who’s overdoses on drugs,” he added.
“So through all the challenges and the hardships, finding ways to maintain a level of compassion and approach people as one human to another is probably the most important thing.”
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