Just In: New Jersey legislature authorizes its paramedics to administer buprenorphine to patients after reviving them, for a “softer landing.”
A Paradigm Shift Amid a Rising Death Toll
FACT: A large number of patients discharged from hospital emergency units after an opioid overdose died within the first month, and approximately one-fifth of those died in the first 2 days.
It’s a crisis within a crisis. The short-term and 1-year mortality of patients treated in an ER for nonfatal opioid overdose is too high, with an estimated 49,000 deaths in the United States in 2017. While many lives are lost, those lives saved by emergency responders immediately enter the “window of highest risk.” We’re fighting to save lives from addiction–and now we’re in the battle to beat the odds and encourage treatment.
FACT: Of the patients treated in an ER for overdose, more than 5% died within 1 year. It’s particularly tragic, given the relatively young age of those who died: the median age was only 39 years. The loss of life at this young age is responsible for an overall decreased life expectancy observed in the United States for the past 2 years, the first decrease in more than 2 decades.
In a recent study reported by The Annals of Emergency Medicine, 17,241 patients in Massachusetts were treated for opioid overdose. Of the 11,557 patients who met study criteria, 5.5% died within 1 year, 1.1% died within 1 month, and 0.25% died within 2 days. Of the 635 deaths at 1 year, 20.5% occurred within 1 month and 4.6% occurred within 2 days. It’s the textbook definition of a true national emergency.
It is against this grim backdrop that New Jersey has taken the bold and unprecedented step of authorizing paramedics to start addiction treatment at the scene of an overdose.
Administering Buprenorphine On Scene Could Serve As An Immediate Transition To Longer-term Treatment
Buprenorphine, which binds to the same brain receptors as opioids used for pain, can provide a “softer landing” for patients recovering from overdose, said Dr. Dan Ciccarone, a University of California, San Francisco, professor who studies heroin use and the opioid epidemic.
“Here we are basically suggesting that we’re going to treat the person in as well-meaning and patient-centric a manner as possible,” Ciccarone said. “And that means naloxone plus a softer landing with buprenorphine.”
ER Visits Continue To Rise
The nation’s emergency units and EMT responders are at the front line of caring for patients who overdose. There were 92,000 ER visits for unintentional, nonfatal overdoses in 2014 in the U.S. Reports from 45 states indicate that there were 142,557 ER visits for suspected opioid-involved overdoses between July 2016 and September 2017, a staggering average increase of 5.6% per quarter.