Buprenorphine/Naloxone (Suboxone)​

Patient Journey AFTER Paramedic Care​

Rationale for this tip​

• SWORBHP is providing education regarding the use of Suboxone during MCME 2024. Here we present Tip 4 of 4 about the new drug!​
• Buprenorphine/Naloxone (Suboxone) is now listed within the Opioid Toxicity and Withdrawal Medical Directive to treat patients suffering from precipitated withdrawal associated with opioid use. ​
• See posts #1-3 for a description of Suboxone, how it fits into the Medical Directive and some pearls about this drug.

ED Care after Pre-Hospital Suboxone Dose​

• Investigations and treatment, as required following opioid overdose​
  • Were there any injuries from the overdose (CPR-related, falls etc.)?​
  • Are there any other health issues to be addressed (wounds, infections etc.)​
• Monitor and treat any ongoing opioid withdrawal​
  • May include further ED dosing of suboxone​
• Arrange follow up and plan for ongoing treatment​
  • Addiction Medicine clinic and/or primary care provider (region dependent)​
  • Script for Suboxone to manage symptoms until follow up​
• Provide take-home naloxone kit

Post ED Care: Ongoing Suboxone Treatment​

• Follow-up in primary care or addictions clinic ​
• Dose adjustment of Suboxone to treat opioid ​
• withdrawal symptoms and cravings ​
• Patients can be offered Sublocade which is a monthly injectable form of buprenorphine, once they are stabilized on a Suboxone dose ​
• Wholistic health screening and management:​
  • Screening and treatment for sexually transmitted and blood-borne infections
  • Treatment for other substance use disorders ​
  • Psychosocial treatment (e.g. counselling) for substance use disorders, applications to bed-based treatment, assistance in obtaining housing and more! ​

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​
• Following Paramedic treatment, the patient will be assessed and treated in the ED​
  • Investigations as required​
  • Symptom optimization​
  • Follow up care arranged for ongoing addictions management​
• Follow up after ED visit will involve ongoing Addiction Medicine care​
  • Ongoing suboxone, consideration for sublocade, wholistic management

No additional resources available for this #SWORBHPTip.