Paramedic Logan Martin at his headquarters in Ottawa on March 26th. She spearheaded the way paramedics respond to mental health/drug crises.Dave Chang/Globe and Mail
A team of specially trained paramedics in Ottawa is trying a new approach to treating opioid overdoses by bringing extra medication to emergency calls.
Naloxone is widely used by family members, bystanders, and medical professionals to reverse opioid overdoses. However, this life-saving drug counteracts and blocks the effects of opioids, sending recipients into immediate withdrawal and causing severe side effects. This leaves patients in excruciating pain, unable to consider treatment options, and seeking more medication to alleviate withdrawal symptoms.
Logan Martin, program leader for the Ottawa Paramedic Service’s mental health response team, is spearheading the new initiative, which launched in March. The idea is to train and equip teams of paramedics to sell buprenorphine and naloxone as a single drug. The brand is named after a person who was resuscitated using only naloxone.
“Naloxone can literally save lives,” Martin said. “The problem is, after someone takes this drug, they have severe withdrawal symptoms. People say it’s the worst thing they’ve ever experienced. They feel like they’re going to die from withdrawal.”
Data shows drug overdoses are the leading cause of death for youth aged 10 to 18 in B.C.
Adding a new drug can reduce painful withdrawal symptoms and make patients more comfortable. “Humanitarianism is about making someone feel better,” Martin says. “But also, when people feel better, they’re more likely to discuss their options more openly.”
Martin’s team is specially trained to respond to mental health-related calls, and unlike other emergency workers, they don’t have to transport patients to the hospital. The team has established partnerships with local hospitals, including the Royal Ottawa Mental Health Centre, a leading mental health institution, to provide patients who recover after an overdose with access to one-day follow-up. ing. Martin also developed a partnership with Ottawa Public Health to better connect people with other health services, including wound care, harm reduction supplies, and potential treatments.
Buprenorphine has been used to treat addiction for many years, but it is usually given as a single dose as part of a structured outpatient treatment program, and many people opt out of the program for a variety of reasons, including not having a primary care physician. is not available.
medicine An opioid that blocks the effects of other opioids. This means it’s harder to overdose while taking it, reducing withdrawal symptoms and reducing cravings without causing euphoria.
Opioid-related deaths soar among Ontario teens and young adults from 2014 to 2021: report
According to the Public Health Agency of Canada, approximately 6,000 people died from opioid overdoses in Canada between January and September 2023, the largest number since data collection began in 2016. Last July, the Ontario government made changes to allow emergency medical services to use a combination of buprenorphine and naloxone to resuscitate people who have overdosed. The process of changing treatment protocols across jurisdictions can be time-consuming, but more health organizations are taking notice, Martin said. .
She first heard about the protocol from a Timmins paramedic last spring. They began using Suboxone for overdose emergency calls even before receiving formal approval from the state Department of Health. The Cochrane region, which includes Timmins and surrounding areas, has one of the highest overdose death rates in the province, and was the first jurisdiction in Canada to use Suboxone in this way. The Porcupine Health Unit, which serves Timmins and surrounding areas, had an overdose death rate of 56.6 per 100,000 people as of March 2023, according to the latest data available from Public Health Ontario. The state’s overdose death rate was 19.5 per 100,000 people in March 2023.
“It’s really important that we pursue that,” said Seamus Murphy, deputy chief of standards and community services for the Cochrane District Paramedic Service. “The lives you save today could be different tomorrow.”
Mr. Murphy’s niece died of an opioid overdose two years ago, an event that brought the toxic drug crisis to the forefront of Mr. Murphy’s mind and reinforced his belief that more action was needed. That’s why Murphy and his team started administering Suboxone last year, even before state mandates, Murphy said.
So far, he says, the results have been positive. The Cochrane area, which has a population of about 78,000 people, responded to 231 overdose calls last year. Of these, 14% died. Twelve percent received a combination of buprenorphine and naloxone after resuscitation. Murphy said 11% of those treated entered long-term treatment, a much higher rate than expected. (Not all patients will receive Suboxone because they do not have severe withdrawal symptoms or meet other clinical criteria.)
Opioid crisis in a small town hidden in the shadow of a big city
Paramedics on Martin’s team have the flexibility to stay with patients for extended periods of time, counseling patients and referring them to community resources and medical professionals.
It also avoids emergency rooms, eliminating unnecessary long wait times and allowing us to focus on quickly connecting individuals to the right mental health support.
Mike Sowierre, director of patient care services for the Royal’s Substance Use and Co-occurring Disorders Programme, said it was critical to have immediate access to a medical professional who specializes in addiction and treatment.
“Having that information during a crisis can be a motivating step for them to seek care,” he says. “There’s a stigma around drug use. If he has to wait six to eight hours in the emergency room, he may not be able to take the next step toward treatment.”
Paxton Buck, co-medical director of the British Columbia Center on Substance Use, said Suboxone is the “gold standard” treatment for opioid use disorder and allowing it to be dispensed by paramedics could reduce the risk of overdose. He said that this could be useful in dealing with the situation.
Dr. Bach noted that people often interact with the health care system weeks to months before dying from an opioid overdose, and that buprenorphine and naloxone should be administered early in such situations to prevent fatal outcomes. suggested that it could be used for. He said it’s too early to tell whether the paramedic-led Suboxone program will have long-term benefits, but he applauds the efforts of those working to expand access.
“It’s important to proceed cautiously and thoughtfully and make sure we’re taking appropriate precautions, but I also think this is a very low-risk drug,” Dr. Bach said.
