The following is a sneak peak into MCME 2024...

​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 pathways.​
• Patients started on buprenorphine/naloxone pre-hospital have the potential to remain on long-term opioid agonist treatment. 

What is buprenorphine/naloxone? 

• Trade name: Suboxone ​
• Buprenorphine:​
  • 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, the naloxone has no effect (i.e. the patient will feel the effects of buprenorphine and have diminished opioid withdrawal symptoms)​
    • If Suboxone is crushed and injected, the naloxone will be active (i.e. naloxone will bind to opioid receptors and antagonize, thus preventing the buprenorphine from binding the opioid receptors and patients will not feel the effects of the opioid and will continue to have withdrawal symptoms). 

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. ​
• Stay tuned for parts 2, 3 and 4 for more information on this treatment!

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