Buprenorphine/Naloxone (Suboxone)

Part 3 of 4 | Extra info on this Drug​

A sneak peek into the 2024 MCME

 

Rationale For This Tip

SWORBHP will be providing education about the use of Suboxone during MCME 2024. Here we present part 3 of 4 on the drug to get you excited for 2024!

Buprenorphine/Naloxone (Suboxone) is now listed within the Opioid Toxicity and Withdrawal Medical Directive for paramedics to treat patients suffering from withdrawal symptoms associated with opioid use.

See post #1 and #2 for a description of Suboxone and how it fits into the Medical Directive.

 

Adverse Effects of Buprenorphine/Naloxone ​

For any drug you administer, it's important to be aware of adverse effects and know how to manage them should they arise

Let's review some things to watch for with Suboxone administration

 

Adverse Effects of Buprenorphine/Naloxone ​

1) Respiratory or CNS depression if mixed with benzodiazepines or alcohol

• Built-in safety of Medical Directive: Patients must be unaltered in order to receive this medication
• Management: Supportive care as required​

2) Can precipitate withdrawal

• Built-in safety of Medical Directive: Patients must be unaltered in order to receive this medication
• Management: Administer an additional dose of Suboxone ​**Paramedics are authorized to administer 2 doses, beyond this a patch to BHP for consultation is required

3) QTc prolongation​

• Very rare risk of Torsades de Pointes due to R-on-T phenomenon with prolonged QT​
• Does not require paramedics to monitor QTc (outside of scope)​
  • However, this is something to be aware of and consider placing the patient on the cardiac monitor
• Management: If patient develops Torsades de Pointes, treat ventricular rhythm with defibrillation per the Medical Cardiac Arrest Medical Directive

Bottom Line on Buprenorphine/Naloxone (Suboxone)​

• When trained and authorized, Paramedics will be administering Suboxone to patients who have received Naloxone and are now experiencing symptoms of withdrawal
• There are known adverse effects of this medication paramedics should be aware of and know how to treat including:​
  • CNS depression​
  • Acute withdrawal​
  • QTc Prolongation

 

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