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Clinical Bulletin on OUD, Buprenorphine/naloxone, and Naloxone

18 January 2024

A new RPPEO Clinical Bulletin on Opioid Use Disorder, Buprenorphine/naloxone, and Naloxone is now available.

This Clinical Bulletin provides paramedic practice guidance from the Regional Medical Director on the appropriate administration of naloxone in the context of opioid toxicity, and differentiates naloxone from the new combined medication for opioid withdrawal in the prehospital context, buprenorphine/naloxone.

Paramedics are invited to consult Health Canada's posted version of the Canadian monograph for buprenorphine/naloxone (trade name "Suboxone") for more detailed information of this new drug's pharmacology, indications, contraindications, and risk management.

We invite paramedics who have questions or concerns about this Clinical Bulletin, naloxone, buprenorphine/naloxone, Opioid Use Disorder, or opioids more generally to contact

Note that RPPEO has not yet authorized any paramedic use of the auxiliary aspects of the Opioid Toxicity and Withdrawal Medical Directive in the ALS PCS. While buprenorphine/naloxone is not yet available for paramedic administration within the RPPEO jurisdiction, we are planning the infrastructure and training needed to support implementation of this important treatment.

Each paramedic may find their current practice authorizations in the most recent RPPEO Certification Letter available within the 'My Profile' section on MedicNET. When RPPEO issues a new Certification Letter, it is also provided to the paramedic via email.

This is the first RPPEO Clinical Bulletin. The format is intended to provide clinical discussion about issues affecting paramedic practice. RPPEO Clinical Bulletins communicate the best front-line strategies for emerging clinical issues in the region using rich formats with text, images, charts or other visual supports. In contrast to Medical Advisories, Clinical Bulletins do not provide new direction; rather, they clarify concepts and inform paramedics and other partners about clinical practice.

RPPEO Clinical Bulletins are available at in the RPPEO Policies section.