Suboxone Patch Removal
Question# 910
In light of the recent article published by Dr Austin and Dr Froats in CJEM on the urgency of the opioid crisis and some of the barriers both paramedics and our patients face, where do we stand on potentially removing the regional patch point for Suboxone administration?
Answer:
We’re glad you had the chance to read the article, and we appreciate the thoughtful and important question it prompted.
This represents a new and meaningful opportunity for paramedics to apply a more holistic approach to a patient population that has long been underserved. Like any evolving model of care, this shift requires learning and adaptation – not just for paramedics, but also for Base Hospital Physicians and other healthcare providers.
The urgency about buprenorphine/naloxone isn’t about the medication itself, or the speed of the administration – rather it’s about the patient in front of you. It’s about shifting the way paramedics engage with individuals who use substances: encouraging meaningful conversations, exploring treatment options, understanding local pathways, and recognizing when on-scene medication administration might be appropriate. It is not a one-size-fits all approach. It’s about equipping paramedics to see beyond the immediate crisis, to distribute naloxone, and to plant the seeds of recovery.
There are many paramedics in our region, including your peers, espousing this holistic approach. The intention of this message is broader than this – the paramedics, the leadership, the administrators, the educators, the base hospitals – across the country.
One way you can assist in continuing your advance towards independent practice is through clear documentation of the outcomes of your assessments, discussions and treatments. We would like to see reassessments after suboxone administration, like serial COWS scores and commentary on how the patient is feeling after administration. This will help us know if paramedics and BHPs and the system is selecting patients appropriately, or if adjustments are required. Once we know paramedics (and the directive) are comfortable selecting the right patients for safe use, the importance of the patch point diminishes.
You are among the first in Canada to provide this level of care to these patients, and that’s something to be proud of! We appreciate your continued advocacy with this patient population.
This represents a new and meaningful opportunity for paramedics to apply a more holistic approach to a patient population that has long been underserved. Like any evolving model of care, this shift requires learning and adaptation – not just for paramedics, but also for Base Hospital Physicians and other healthcare providers.
The urgency about buprenorphine/naloxone isn’t about the medication itself, or the speed of the administration – rather it’s about the patient in front of you. It’s about shifting the way paramedics engage with individuals who use substances: encouraging meaningful conversations, exploring treatment options, understanding local pathways, and recognizing when on-scene medication administration might be appropriate. It is not a one-size-fits all approach. It’s about equipping paramedics to see beyond the immediate crisis, to distribute naloxone, and to plant the seeds of recovery.
There are many paramedics in our region, including your peers, espousing this holistic approach. The intention of this message is broader than this – the paramedics, the leadership, the administrators, the educators, the base hospitals – across the country.
One way you can assist in continuing your advance towards independent practice is through clear documentation of the outcomes of your assessments, discussions and treatments. We would like to see reassessments after suboxone administration, like serial COWS scores and commentary on how the patient is feeling after administration. This will help us know if paramedics and BHPs and the system is selecting patients appropriately, or if adjustments are required. Once we know paramedics (and the directive) are comfortable selecting the right patients for safe use, the importance of the patch point diminishes.
You are among the first in Canada to provide this level of care to these patients, and that’s something to be proud of! We appreciate your continued advocacy with this patient population.