New program will help people recover from opioid withdrawal, connect with treatment

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Among hundreds of 911 calls for opioid overdoses, Salem’s emergency responders often see the same people. 

Sometimes they have to administer CPR to save someone who they gave naloxone, an overdose-reversal drug, the day before. 

“We see these patients, and it’s just heartbreaking when you run on someone that you’ve taken to the hospital yesterday or the day before, and you’re at their house again for another overdose, and you’re talking to them again with more Narcan,” Nicholas VanEpps, clinical manager for Falck, Salem’s private ambulance provider, said. “Nothing grinds a paramedic more into the ground than trying desperately to save someone or to help someone, and they can’t.” 

A new program among Salem’s emergency services could reduce the number of people going through multiple overdoses and help them get into treatment immediately by providing medication in the field to kick-start recovery.

Starting March 10, Salem ambulances and hospitals will start administering and prescribing buprenorphine, a medication that reduces withdrawal symptoms, to patients being treated for overdose. 

While Narcan saves lives, it does so by immediately flushing opioids from a patient’s body, putting them quickly into a painful withdrawal. That often leads people to immediately use drugs again to curb the symptoms.

Giving them buprenorphine provides a chance to break that cycle.

Once they’re not feeling withdrawal symptoms “they’re thinking rationally. They’re thinking more clearly. They’re not being driven by a desire to use again, they can maybe even see it more of a light at the end of the tunnel, that if I’m scared to quit because withdrawal is hell, this reduces withdrawal,” VanEpps said.

The new emergency response comes from the California-based Public Institute of Health’s Bridge Center, which is a nonprofit-run program to teach emergency departments to better treat patients with substance abuse problems. 

In partnership with the Oregon Health Authority and the Oregon Public Health Institute, the Bridge Center is leading a six month pilot of the program in Marion and Multnomah counties. 

The Bridge Center has funded similar pilots across the U.S. since 2018. Their goal is to have a standard treatment system in place for opioid abuse that’s based on evidence, regardless of the size of the community or health system involved.

“It’s having these expectations of certain levels of care. We have it for sepsis, we have it for stroke, and we have it everywhere, and so it’s bringing this very high risk issue where so many of our loved ones are dying, and bringing it in and making it that important, and trying to make care much more like what you can expect,” said Arianna Campbell, one of the center’s principal investigators.

Falck responders see several calls to Narcan-induced withdrawals every day. Some end in physical assaults on responders due to the physical pain and “debilitating condition” withdrawal puts people in, VanEpps said.

“We’ve done a great job of preserving life, but we can do better when it comes to reducing suffering,” VanEpps said. “You can’t just save a life, but if the life is now suffering, that’s a whole different conversation.”

Last year, VanEpps said, Falck responded to 492 opioid overdose calls where Narcan was used to wake the person up. 

“What is their motivation at that particular point? It’s to use something that takes me out of withdrawal, scratch the itch, if you will,” he said.

People who overdose on opioids have a high likelihood of dying from another opioid overdose in the next year, according to VanEpps. A majority of those deaths happen within one month of the previous overdose. 

Even though Narcan used by paramedics and others in the community has saved lives, that can often be where the care or treatment ends. 

In the last few weeks, around 100 Falck employees received training on how to assess people in opioid withdrawal and administer the medication, which comes in a strip. 

Buprenorphine starts easing withdrawal pains in less than 10 minutes and can stay in someone’s system for up to 48 hours. 

After Falck delivers a patient to Salem Hospital, they will get evaluated by a physician. If the patient is diagnosed with opioid use disorder, they can get a prescription of buprenorphine and learn about counseling and treatment options. 

Salem Health’s treatment partners include Marion County, Bridgeway Community Health and Great Circle Recovery, according to Michael Gay, Salem Health’s government relations director. 

Gay said in an email that all providers at Salem Hospital’s emergency department received training on the Bridge program.

The Bridge pilot ends June 30 which is also when Salem’s ambulance services will transition from Falck to the Salem Fire Department, which will continue the program starting July 1. 

Throughout the transition, Salem Hospital will continue evaluating patients and prescribing them medication or referring them to local treatment providers, Gay said in an email. 

The program pilot is getting $300,000 from the state health authority and $140,000 from the Oregon Public Health Institute and the Bridge Center, according to an OHA statement. VanEpps said Falck is responsible for providing buprenorphine, which costs around $5 per dose. 

Opioid overdoses have been increasing in Oregon for the last several years, and in 2023, Salem Hospital saw its highest number of opioid overdoses in almost 10 years. 

Campbell and Oregon Public Health Institute executive director Emily Henke agree that the pilot is a start to what they hope is a systematic improvement of health care for Oregonians with substance and opioid use disorders. 

“Right now, we’re working hard on this. We’re working on the emergency responders, we’re working on the emergency departments, but we really do have a like, full picture systems view here, and hope that that’s something that we can really dive in on in the next phases of this work after we get this small pilot up and running,” Henke said.

Contact reporter Madeleine Moore: [email protected].

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