Date Published

February 21, 2024

Updated For

ALS PCS Version 5.2


Buprenorphine/Naloxone (Suboxone)

Part 1 of 4 | Rationale and Description of the 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 1 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.


Opioid use disorder and related ED visits, hospitalizations and deaths have been rising in ON

  • A 2022 study showed that 1 in 2 individuals who died of opioid-toxicity had a healthcare encounter in the 30 days prior to their death and 1 in 4 had an encounter within 7 days of their death.
  • Encounters with EMS are an opportunity to positively impact a patient’s journey though the healthcare system by offering a medication or alternative harm-reduction pathway.
  • Patients started on buprenorphine/naloxone pre-hospitally have the potential to remain on long-term opioid agonist treatment. ​


What is Buprenorphine/Naloxone? ​

Trade Name: Suboxone


  • Long acting, partial agonist with high-affinity at the mu-opioid receptor​
    • Long acting = reduces withdrawal and opioid cravings​
    • Partial agonist = Less risk of respiratory depression and overdose than other opioids​
    • High affinity = binds strongly to the opioid receptor and can prevent other opioids from binding, can “knock off” other opioids that are already bound

Naloxone: ​

  • Opioid antagonist
  • Discourages patients from injecting tablets​
    • When Suboxone is taken orally, naloxone has no effect ​
    • When injected, the naloxone is activated and prevents patients from feeling the effect of any opioid


Bottom Line on Buprenorphine/Naloxone (Suboxone)​

  • Opioid use and negative outcomes are on the rise: ​
    • There were over 40,000 apparent opioid toxicity deaths between January 2016 & June 2023.​
    • The number of apparent opioid toxicity deaths in 2023 is 5% higher than previous years (preliminary data as of June 2023). ​
  • Paramedics may be able to make a positive impact in this patient population by initiating withdrawal treatment with Suboxone.


Additional Resources:

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