Community Health & Wellness

Buprenorphine, which helps opioid users after overdoses, being carried by paramedics in Kitsap

Posted on January 22nd, 2025 By: Conor Wilson

Attempting to reduce fatal opioid overdoses and encourage more people to seek treatment, fire department paramedics in Kitsap County will start administering the medication buprenorphine in the field this year.

Buprenorphine, one of three medications approved by the U.S. Food and Drug Administration to treat opioid use disorder, has been around for decades. But its use expanded recently in response to the opioid crisis. Studies indicate the drug significantly reduces fatality rates in people with opioid addictions.

Drugs used to treat opioid use disorder, like buprenorphine, are already available, but typically only at clinics or doctors offices. Putting these types of medications in the hands of first responders — who can provide it immediately after an overdose — is where experts say they are most effective.

Relief from withdrawal symptoms

When prescribed by a medical professional, buprenorphine partially activates opioid receptors in the brain. This provides relief from intense withdrawals and cravings without inducing the euphoric highs or overdose risks from problem opioids like fentanyl.

Those with a prolonged history of substance use often need to continue taking drugs to avoid withdrawals and continue feeling “normal.” That can drive some to reuse.

Buprenorphine provides that same feeling of stability without a high risk of overdose. It also has a “ceiling effect” in which, unlike fentanyl, its risk of overdose and euphoric effects eventually plateau.

“It kind of gives somebody a steady state of opioids on their receptors so that they can be functional,”said Albert Carbo, a clinical pharmacist at the nonprofit Peninsula Community Health Services. “That’s when they can really interact with their counseling team or anybody else and deal with their underlying issues.”

In the hands of paramedics

The Washington state Department of Health launched its buprenorphine pilot program this fall. It was originally introduced to paramedics in King, Spokane, Snohomish, Clallam, Whatcom, Grant, Lewis and San Juan counties. Kitsap is enrolling.

“The Department of Health is determined to help Washingtonians live healthy and fulfilling lives, and to stop this opioid crisis from robbing those lives from our neighbors, friends, and family members,” Dr. Umair Shah, the state secretary of health, said in a statement. “This pilot program will help us reach that goal and will put critical care closer to the people who need it most.”

The Kitsap Public Health District is working with the county medical director and chiefs from six local fire agencies to update protocols for buprenorphine. They expect launch in the middle of 2025, said Poulsbo Fire Chief Jim Gillard.

“It’s really taken off across the country,” he said of buprenorphine. “It is at least something we can do to try to prevent the harm from fentanyl.”

Like other departments in the county, Poulsbo responds frequently to calls involving overdoses of opioids, Gillard said. Fatal overdoses have increased annually in Kitsap County since 2020, mostly due to the presence of fentanyl, a synthetic opioid 50 times stronger than heroin.

Kitsap saw a record number of fatal overdoses in 2023, the most recent full-year available. Numbers have declined slightly through the first half of 2024, based on preliminary results, but remain high.

‘Giving them a chance’

First responders and law enforcement started carrying naloxone, a medication often given via a nasal spray that reverses the effects of an opioid overdose, to combat the increase. The antidote has been used for at least a decade in Kitsap County, with its accessibility rapidly expanding in recent years.

Naloxone, sold under the brand Narcan, offers short term relief from opioids. But its protective effects can wear off in 30 to 90 minutes, according to the National Institute on Drug Abuse. Many opioids remain in the body longer, putting those revived with naloxone in a vulnerable position. They may experience intense withdrawal symptoms within minutes after being revived.

That is where buprenorphine can be beneficial. Administering the medication can prevent full-body aches, fevers, vomiting, insomnia and other painful parts of withdrawal. Reducing these outcomes will increase the chance someone will engage with treatment, Gillard said.

“It isn’t going to be a very high percentage of the time we give [buprenorphine] that someone actually successfully goes through treatment – and that’s frustrating – but we’re giving them a chance,” he said. “We’re improving the odds.”

Gold standard

Although buprenorphine was approved as a treatment of opioid use disorder in 2002, only in the last decade or so has it started to gain widespread traction.

Buprenorphine has historically been heavily regulated and considered a medical speciality. Before a federal policy was changed in 2023, practitioners were required to get additional training to prescribe it.

“When I got here eight or nine years ago, buprenorphine was not available in our county to a meaningful extent,” said Carbo, the PCHS pharmacist. Now “I would imagine a vast majority of [primary] providers at least consider it.”

PCHS, for example, went from about 5 to 30 practitioners prescribing the medication over that span, he said. In 2019, they also started a program that administered it to inmates at the Kitsap County Jail.

Part of the challenge for buprenorphine has been that American substance abuse treatment programs have historically favored or recommended abstinence-only models. Medication in treatment is often criticized as replacing one drug with another. While that is technically true, experts say the switch is more nuanced.

Skepticism

Research from the American Medical Association has found buprenorphine to be a safer alternative to illicit opioids. Patients are at a “significantly lower” risk of death than those who continue using fentanyl or heroin.

Some clinicians continue to be skeptical of medications like buprenorphine, said Wayne Swanson, director of subacute recovery at Kitsap Mental Health Services. But a new generation of clinicians have begun to view buprenorphine as the “gold standard” for opioid treatment.

No one thing can be a silver-bullet to treating addiction, Swanson said. Substance use and its causes are complex. Still, buprenorphine has been effective.

“I’ve seen more sustained recovery from opioid use disorder with the use of buprenorphine – without a doubt,” he said. The pain and physical challenge alone is easily underestimated.

“Old-school, abstinence-based models that wouldn’t incorporate something like buprenorphine had an abysmal success rate with opioid users because it’s just so physically challenging,” he said.

Key to success

Dr. Gib Morrow, Kitsap’s top public health officer, said the challenge for the pilot program will be what happens to people after they are revived with naloxone and treated with buprenorphine. Many will need longer-term support, counseling and medical care.

Moments of crisis, like an overdose, present an opportunity for emergency responders to engage with people, Morrow said, on a “path to healing, hope, and meaningful recovery.”

“Successful reversal of an opioid overdose, in which a person is snatched from death by administration of naloxone, should soon be a timely opportunity for meaningful connection with our healthcare system in Kitsap,” he wrote in an email.

Some patients will also need a facility that offers long-term medication management. Experts consider substance use a chronic condition, akin to diabetes or depression. Buprenorphine, they say, is comparable to taking antidepressants or insulin.

Some patients may take buprenorphine for a short period to get over initial withdrawals and restore social and psychological support. For others it can be taken indefinitely and help carry them through recovery.

“We’re very much in support of buprenorphine and don’t see it in, in contrast to abstinence,” Swanson said. “We see it as a support medication like any other.”

Conor Wilson is a Murrow News fellow, reporting for Gig Harbor Now and the Kitsap Sun, a daily newspaper based in Bremerton, through a program managed by Washington State University.