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🎧 Episode Summary:
In this episode of the Pre-Hospital Paradigm Podcast, host Scott Wildenheim is joined by Dr. John Hill, AJ, and returning guest Dr. Jordan Singer to dive deep into the EMS response to opioid use disorder. They explore the evolving landscape of harm reduction, including field administration of Suboxone (buprenorphine), leave-behind Narcan (naloxone) kits, and strategies for reducing stigma. From overcoming operational hurdles to expanding EMS roles in addiction medicine, this conversation provides practical tools, real-life stories, and expert insights on how EMS can help save lives and guide patients toward recovery.

🧭 Key Topics Covered:

1. Beyond the Overdose: Addressing the Chronic Disease

• EMS typically handles the acute overdose—but what happens after?
  
  

• Opioid use disorder (OUD) as a chronic condition, not a character flaw.
  
  

• Resuscitating patients buys time; recovery requires continued support.
  
  

2. Leave-Behind Narcan Programs

• Overview of Project DAWN and its integration with EMS agencies.
  
  

• Who should receive Narcan? (Hint: almost anyone at risk—including elderly patients on prescribed opioids.)
  
  

• Dispensing logistics, documentation, and overcoming provider stigma.
  
  

• Dispelling myths: Narcan doesn’t “enable” use—it prevents death.
  
  

3. Suboxone (Buprenorphine) Use in the Field

• Indications, mechanism, and safety profile of high-dose buprenorphine.
  
  

• Why EMS is ideally positioned to initiate treatment for withdrawal.
  
  

• Use of the COWS (Clinical Opioid Withdrawal Scale) to determine candidacy.
  
  

• Barriers to wider adoption and legal framework for EMS dispensing.
  
  

4. Overcoming Prehospital Stigma

• Harm reduction is not enabling—it’s life-saving.
  
  

• Respectful language: stop using terms like "addict" or "user."
  
  

• How EMS providers can show empathy and gain patient trust.
  
  

• Personal stories illustrating the transformative power of human connection.
  
  

5. Recovery Pathways and Community Partnerships

• EMS’s role in bridging to long-term recovery care.
  
  

• Working with local agencies to provide rides, warm handoffs, and follow-up support.
  
  

• The importance of integrating social services with medical care.
  
  

🧪 Clinical Pearls & Protocol Highlights

• Leave-behind Narcan: Safe, easy to use, and can be given to family/friends.
  
  

• Suboxone: Administer 16–24 mg if COWS score ≥5; effective within minutes; lasts 24–72 hours.
  
  

• Never give bupe to someone on methadone within 48 hours—risk of precipitated withdrawal.
  
  

• Buprenorphine is extremely safe—even accidental use in the wrong context is low-risk.
  
  

• Pregnant patients should not be excluded—call medical control if uncertain.
  
  

📢 Notable Quotes:

“These patients aren’t defined by addiction—they’re defined by their humanity. Meet them where they are.”
“The goal isn’t just to save them today—it’s to keep them alive long enough to choose recovery.”
“Narcan doesn’t enable drug use—it enables life.”

💡 Final Thoughts:
The future of EMS includes proactive, compassionate care for vulnerable patients with substance use disorders. Suboxone and Narcan are just the beginning. As providers, we have a moral and medical imperative to reduce harm, treat addiction like the disease it is, and change the trajectory for those we encounter—1 compassionate encounter at a time.

From The Episode