By Catalina Gaitán
The Seattle Times
SEATTLE — Starting November, Seattle will become the first U.S. city where emergency medical technicians and firefighters in the field can use buprenorphine to treat people who have overdosed on fentanyl, according to city officials.
The announcement follows the success the city has had with its paramedics administering the medication since February. If used regularly, experts say, buprenorphine can reduce fatal overdoses by nearly 70% and help people recover from opioid use disorder.
Within the next three weeks, a group of about 20 Seattle Fire Department’s 911 EMTs and firefighters will finish training and start treating overdose patients with buprenorphine — also known as “bupe” or by the brand name Suboxone, said agency spokesperson Kristin Hanson. They will join about 35 of the department’s 55 paramedics already administering the medication.
The pilot is the city’s latest effort to combat a drug crisis fueled by fentanyl, a synthetic opioid up to 50 times stronger than heroin and behind skyrocketing overdose deaths in Washington and across the United States.
Administered after someone is rescued with Narcan, an opioid overdose reversal drug, buprenorphine protects against an overdose and quickly blocks intense withdrawal symptoms, including diarrhea, vomiting and muscle pain for about one day.
Between Feb. 20 and Oct. 9, paramedics in the pilot administered buprenorphine to 39 patients.
A review of 16 of those patients found that 12 coordinated with fire department employees to reach their appointment for further substance use disorder treatment, Hanson said.
The temporary reprieve from “the roller coaster” of withdrawal gives patients time to access lifesaving medications and services, instead of needing to seek out more fentanyl immediately after an overdose, said Caleb Banta-Green, a research professor at the University of Washington School of Medicine.
"(Buprenorphine) wouldn’t be a magic bullet, but it would definitely be a way to bring more people in and get them accepting care,” said Marco Pravetoni, a fellow UW Medicine professor and clinical researcher who specializes in opioid use disorders. “It can become a bridge to actual treatment.”
The pilot aims to meet “patients where they’re at,” instead of only administering the medication in medical facilities, Seattle Fire Department Chief Harold Scoggins said in a statement earlier this month.
The Washington Department of Health is collaborating on the pilot and granted approval to administer the drug.
The participating firefighters and EMTs are all members of the city’s Health 99 and Health One units, Hanson said. Those units team up firefighters or EMTs with social workers to respond to overdoses and emergencies and to connect them to services.
The pilot shows promise, said Pravetoni, as people with opioid use disorder are usually more likely to agree to accept buprenorphine in the field instead of after being checked into a hospital or emergency department. Usually, an overdose patient is unconscious when they are treated with Narcan, and a first responder will ask the patient whether they want to take buprenorphine once they are alert, he said.
Patients given buprenorphine after an overdose were also more likely to schedule follow-up appointments and obtain prescriptions for opioid use disorder medications, according to a study conducted by the fire department and Seattle’s Harborview Medical Center on the pilot’s initial results.
“If EMTs are responding to an overdose and a person is in withdrawal, that person is going to use again,” Banta-Green said. “And if we don’t offer them buprenorphine, they’re going to use fentanyl, because a person with untreated opioid use disorder is going to use the opioid that’s easiest to get.”
While the single dose of buprenorphine helps short-term, opioid use disorder research shows the medication is most effective when used long-term or potentially for life, similar to how insulin is used to treat diabetes, he said.
When used consistently, such as a daily sublingual strip or tablet or an injection that lasts up to 28 days, buprenorphine can reduce fatal overdoses in a population by up to 68%, according to a study by Banta-Green and other researchers. When only Narcan is used, that figure is just 4%, Banta-Green said.
Officials in King County are trying to make buprenorphine and other treatments more accessible, such as making them available in more clinics, he said. The medication is covered by Medicaid, Medicare and most private insurance and costs between $80 and $200 a month.
There are about a dozen clinics in King County where people can pick up prescriptions for buprenorphine on a drop-in basis, Banta-Green said, including at Auburn’s HealthPoint clinic and Bupe Pathways and the Seattle Indian Health Board in Seattle.
The UW Department of Emergency Medicine and Public Health — Seattle & King County also launched a 24/7 “Telebup” hotline at 206-289-0287 in January, where anyone 13 years or older with opioid use disorder can have a telehealth appointment and be prescribed buprenorphine within 72 hours.
Between 2018 and 2023, 9,251 people in Washington died from opioid use, according to the Washington Department of Health. The Seattle Fire Department is responding to more suspected overdose calls each year, going from 2,667 in 2020 to 6,538 in 2023. So far this year, the fire department has responded to 4,076 suspected drug overdoses and administered Narcan in 1,051 of those calls, Hanson said.
Easier access to treatments such as buprenorphine, along with more education and trained personnel administering the medication “in the streets,” is vital for combating the fentanyl crisis, Pravetoni said.
“You have to make methadone and buprenorphine at least as easy to get as fentanyl, and fentanyl is $3 and you can get it in three minutes,” Banta-Green said. “If you want to compete with that, you have to make it easy to get.”
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