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Missouri pilot program trains EMS crews to give overdose victims addiction meds

An ambulance approaches the Amazon Fulfillment Center in St. Peters, Mo. on Wednesday, Oct. 11, 2023. Workers remarked that ambulances being called to the warehouse is a regular occurrence.
Tristen Rouse
St. Louis Public Radio
Emergency medical workers frequently reverse opioid overdoses with naloxone. A pilot program in six EMS districts throughout Missouri is now teaching them to offer addiction medication that eases withdrawal symptoms.

Six emergency medical districts in Missouri will soon distribute an opioid addiction medication as part of a state-funded pilot program.

EMS workers across the state are receiving training on how to give overdose victims a dose of buprenorphine, which manages cravings and withdrawal symptoms, after reviving them from an overdose with the overdose reversal drug naloxone.

“Often when they are reversing overdoses of patients in the field, those individuals will wake up experiencing withdrawals,” said Liz Connors, the director of first responder and public health programming at Missouri Institute of Mental Health at UMSL. “And this is a really critical juncture at being able to respond to that patient's needs and then help get them connected to ongoing services.”

UMSL is coordinating training and distributing funds from the Missouri Department of Mental Health — about $15,000 per participating district — to get the pilot off the ground, she said. When the program is up and running, approximately 500 emergency medical personnel will have learned how to administer the drug.

The Mehlville Fire Protection District, Christian Hospital EMS, and Joachim Plattin Ambulance Districts in the St Louis region are participating, along with the Raytown Fire Protection District and Central Jackson County Fire Protection District in the Kansas City region and MU Health Care in Boone County.

Buprenorphine can come in many different forms, but the workers in the pilot program are using a version that comes in a strip that dissolves on a patient’s tongue, similar to a breath strip.

Buprenorphine can reduce withdrawal symptoms and cravings, which creates a vital window of time to get a person connected to treatment, Connors said.

If a patient is willing, Participating emergency workers and paramedics will conduct an assessment to see how severe their withdrawal symptoms are. If a patient scores high enough, they’ll be able to get a dose of buprenorphine. Workers can then connect them to peer support and expedited treatment through a network of hospitals and addiction counselors.

Connors said that patients will typically be able to get connected to treatment in around two days.

“I want to be clear, this EMS buprenorphine project is a piece of what we are looking at as an overdose chain of survival,” Connors said. “So this is one link in a chain that can help people get on to stabilizing medication when they're feeling the worst.”

The state is using money from the funds it received from a national settlement with opioid manufacturers and distributors to pay for the pilot.

Joachim-Plattin’s six-ambulance district will often respond to more than a dozen overdose calls each month, said the district’s deputy medical officer Gary Stefan. It’s not uncommon to see the same person overdose several times, he said.

That’s led to a lot of burnout and frustration among EMTs, he said.

“We're here to help people. And then we reverse this event, and then you see him maybe hours later,” Stefan said. “You have to scratch your head wondering why this kind of behavior continues. So I think EMS as a whole has put this wall up and we lose instant rapport with these patients.”

He hopes directing patients to treatment will help EMT crews feel less burned out when responding to overdoses. He wants to use the experience to inspire workers to feel more empathy toward overdose victims and reduce the stigma around addiction.

“I think we've had this good guy, bad guy philosophy for many years,” Stephan said “And I think the rapport goes right out the window when this is encountered. So I think we're going to start with some education.”

Spending more time at the scene of an overdose could ultimately cut down on the amount of time seeing repeat overdose victims, he said.

Sarah Fentem is the health reporter at St. Louis Public Radio.