The Contra Costa County Emergency Medical Services (EMS) Pilot Project is the first in the country to launch a pilot project for paramedics to provide medication for addiction treatment (MAT) directly to patients in withdrawal from opioid use disorder. Lead by Dr. Gene Hern, the EMS Project Director of the CA Bridge program at the Public Health Institute, Dr. David Goldstein, of the Contra Costa County Emergency Medical Services Agency, and Dr. Ori Tzvieli, the Medical Director of Contra Costa County Public Health, the project has started serving patients in the region.
This is a critical juncture, as Emergency Medical Services (EMS) have a wide reach and contact with high-risk individuals. This project maximizes the EMS response to provide treatment for opioid use disorder (OUD) and harm reduction measures to both prevent future overdoses and encourage long term treatment. Having paramedics trained in evidence-based OUD treatment makes them a logical point of intervention and an integral part of a system-wide community of caregivers helping people with OUD.
4 Simple Steps for OUD Treatment
This project includes four pillars to support OUD care:
- Buprenorphine Initiation (MAT for OUD) by paramedics
- Data Linkage to care between EMS responders and the Department of Public Health with 72-hour follow-up by a Substance Use Navigator based within a hospital and trained in patient engagement and linkage to ongoing treatment
- Public Access to Naloxone/Narcan program
- Overdose Receiving Center (e.g., a CA Bridge affiliated hospital) with specialized personnel and resources.
One patient who has benefited from the project expressed gratitude to Tambra Divine, a Substance Use Navigator at Contra Costa Health Services who is collaborating with paramedics as part of the pilot. The patient wrote, “Thank you for your help in the early part of this for me. That was the help I needed.” Divine checked in on the patient 30 days later and he responded, “I’m doing really good. Been with my family a lot. Thank you.”
At the 30-day follow-up for another patient, Divine asked about the patient’s experience with the paramedic who administered the medication. The patient replied, “He knew what he was doing. He offered me suboxone [brand name for MAT]!! He really wanted to help me. I never saw this anywhere before. I really appreciate the call. It makes me think people really care.” At the time of the call, he was driving to the pharmacy to pick up his prescription.
Divine’s role as a Substance Use Navigator is to work with paramedics to follow up with patients who’ve been administered buprenorphine in the field to help them with prescriptions and linkage to continued treatment and support. She’s excited to be working with the paramedics, to reach more patients and save more lives. She takes over where they leave off, reminding them to get the phone numbers of patients for her to follow-up with. She makes sure to check in on this vulnerable population, bridging patients to the care they need.
Funding began with the California Department of Public Health (CDPH) for the integration of opioid treatment through EMS. The CARESTAR Foundation funded the project into implementation, providing a proof of concept so that other EMS agencies and health systems roll out similar efforts. “Ultimately, this project has the potential not only to save lives in the community of Contra Costa County but to serve as a model for similar interventions across the state and nation,” Dr. Hern explains. If these changes are integrated across systems of care, the project anticipates fewer overdoses after patient interactions with the EMS system, increased follow-up and retention in ongoing MAT treatment after patient interactions with EMS, and reduced racial disparities in overdose fatalities.
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