Abstract
The opioid crisis is an ongoing public health concern and EMS agencies are in a critical position to reach at-risk populations. The traditional role of EMS in treating acute opioid overdoses has expanded to include preventative strategies as well as long-term treatment and recovery options. EMS agencies are uniquely positioned to partner with local community resources and hospitals to combine efforts in implementing harm-reduction strategies.
In 2017, over 47,000 deaths in the United States were attributable to opioid overdoses, both prescription and illicit (Citation1, Citation2). This constituted two-thirds of all overdose deaths (Citation1, Citation2). Although all ages are affected, most deaths occur between the ages of 15 and 44 (Citation3). Aside from the loss of life and significant burden of disability-adjusted life years lost, the Council of Economic Advisors estimated that the cost of the opioid epidemic in 2015 was over $500 billion (Citation4).
Although there are continued efforts to ensure safe prescribing practices, opioid-involved death rates remain high (Citation2). Numerous national, state, and local programs have targeted reducing deaths from opioid overdoses and supporting addiction recovery efforts (Citation5–9). Community-led efforts such as opioid antagonist distribution are low-risk and suggest reduction in overdose deaths (Citation10–13). However, research demonstrating a longer-term benefit in morbidity and mortality of any given subgroup of patients or to the general public to whom naloxone has been administered is currently lacking (Citation14–18). While the administration of naloxone may stem the immediate mortality of an individual or sector of a community, long-term comprehensive treatment plans that include prevention and harm reduction are needed (Citation19).
Addiction, overdoses, and deaths from opioids are a rising public health concern. These patients are commonly encountered by EMS providers on a daily basis. National Emergency Medical Services Information System (NEMSIS) data on national EMS administration of naloxone showed a 75% increase from 2012 to 2016 (Citation20).
As a health care entity, EMS is uniquely positioned at the interface of public health and hospital-based care. EMS can identify and reach high-risk populations that are affected by the opioid epidemic at critical junctions. This places EMS in an integral position to link these patients to additional community resources such as peer support programs, medication-assisted treatment (MAT), and long-term treatment aimed at recovery. By connecting the patient to resources targeted toward recovery, EMS can not only treat the acute opioid overdose, but also facilitate prevention.
The NAEMSP believes:
Local hospitals, public health departments, community organizations, and other community stakeholders should partner with EMS agencies when implementing harm reduction strategies to collectively minimize opioid deaths in the community.
EMS agencies and medical directors have a role in public safety naloxone administration programs and ensuring the safety of these programs through evidence-based protocols, standardized education, case review, and robust quality improvement.
In conjunction with local partners, EMS agencies should consider referrals to opioid treatment centers or sobering centers as alternative destinations or as a part of a treat-and-refer strategy.
EMS agencies have a role in encouraging community engagement and education on basic life support measures and timely notification of 9-1-1 for potential opioid overdoses. This may involve:
Early identification of high-risk patients to facilitate distribution of naloxone kits and rehab/recovery resources in identified opioid overdoses for refusal patients and patients discharged from emergency departments or hospitals.
Engaging mobile integrated health (MIH) or similar programs to partner with hospitals or other community resources such as opioid management and prevention programs.
EMS is well positioned to engage in medication assisted therapy (MAT) with buprenorphine and linkage to long term care. This can either be initiated at the point of overdose following resuscitation or as part of a prehospital post overdose MIH program to connect to a larger addiction care system.
Using data from EMS and emergency dispatch to identify opioid use hot spots and participation in opioid mapping initiatives (Citation21–23).
State and local governments should adequately fund EMS efforts and resources to reduce deaths from opioid overdoses in their communities.
Medical directors should focus EMS education on the state of the science of addiction causes and treatment options to facilitate early identification and to destigmatize addiction.
Medical directors of EMS agencies should consider use of EMS acute pain protocols and guidelines based on evidence and best practices for opioid and non-opioid analgesia (Citation24, Citation25).
References
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