By Robert Brodsky (source)

It's a frustrating cycle for longtime New York paramedics — one they said they've seen way too often.

They'll revive someone overdosing on opioids with Narcan. But once the patient regains consciousness, the person immediately starts the debilitating symptoms of opioid withdrawal — a problem paramedics aren't legally able to address on the scene with a drug that can help.

A high number of these patients, experts said, refuse EMS transport or check themselves out of an emergency room — often against medical advice and before a conversation about treatment — with the sole intention to feed that craving and find their next drug fix.

Many will overdose again — or end up dead — within 72 hours, treatment specialists said.

WHAT NEWSDAY FOUND

• Gov. Kathy Hochul recently announced she would support legislation allowing paramedics to administer buprenorphine, a drug that reverses opioid withdrawal symptoms after someone is revived from an overdose.
• Other states, including New Jersey and Florida, already allow paramedics to administer buprenorphine, typically after a near fatal overdose.
• Drug treatment experts, doctors and paramedics said the proposal could save lives by creating a window where addicts may be more willing to seek treatment for addiction recovery after an overdose.

But paramedics across the state and throughout Long Island soon could have a new tool to treat those painful withdrawal symptoms in the critical time that comes after saving a life.

During her Jan. 14 State of the State address, Gov. Kathy Hochul said she would support legislation allowing paramedics to administer buprenorphine, a drug that reverses opioid withdrawal symptoms without providing the same type of "high" to the user or the risk of another overdose. 

Paramedics in New York currently are prohibited by law from administering buprenorphine, which, according to the nonprofit National Alliance of Advocates for Buprenorphine Treatment, is a partial opioid that blocks pain receptors and can induce a mild euphoria.  

'Missing link'

Proponents of the plan to equip paramedics with buprenorphine, including Steve Chassman, executive director of the Long Island Council on Alcohol and Drug Dependence, call it the "missing link" in the bridge to recovery for many addicts.

"People are in physical withdrawal, and if you're not stabilizing those symptoms after the Narcan reversal, they're not going to have an open mind because they're just so sick and want to get home," Chassman said. "If you ask most opioid users, they'll tell you their biggest fear is going into withdrawal. It's physically and psychologically wrenching on the body and mind." 

Gregory Miglino Jr., a paramedic for 31 years and department chief of the South Country Ambulance Company in Bellport, said any tool that reduces suffering and promotes a safe recovery process would be a welcome addition.

"Having this drug available, as an additional treatment protocol, to help people in recovery is a step forward," Miglino said. "Addressing people in the throws of addiction is frustrating. Too often there is a lack of resources when people want to enter recovery. If we as paramedics can assist a person in maintaining their sobriety by administering buprenorphine why wouldn't we?"

Unlike in Nassau County, which employs police medics, paramedics in Suffolk are typically contractors with municipalities that fund volunteer departments.

Det. Lt. Scott Skrynecki, a spokesman for the Nassau County Police Department, declined to comment on Hochul's proposal, noting it's in the "proposal stage." 

Dr. Jonathan Berkowitz, EMS medical director at Northwell Health, said the policy change also could improve the mental health of paramedics.

"Having another tool in their toolbelt to potentially help people and not just having a revolving door would help how they cope with the emotional stress of this epidemic," he said.

There were 463 fatal overdoses in Suffolk in 2023, a more than 11% drop from the 523 reported in 2022, according to the county medical examiner’s office. State figures show 210 people in Nassau died from overdoses in 2023, down 16% from 250 deaths a year earlier, Newsday previously reported.

"I think this plan can certainly save lives," said Carole Trottere, 68, of Old Field, whose son, Alex Sutton, died in 2018 of a fentanyl overdose at age 30. "And it can get someone on the path to recovery where they're not just going through that cycle of using and overdosing and needing Narcan."

'Window of opportunity' 

State officials didn't provide details of Hochul's proposal, including the program's cost, the training that would be required of paramedics and under what circumstances they could administer buprenorphine. 

For example, in New Jersey, paramedics can give the drug only after administering Narcan, while many other states allow EMTs and paramedics to administer buprenorphine at the request of people in medical distress. Unlike Narcan, in which there is implied consent, a patient must agree to take buprenorphine in New Jersey.

Paramedics there also are required to get authorization from a hospital physician before administering buprenorphine. It's unclear if New York State would require such authorization.

Chinazo Cunningham, commissioner of the New York State Office of Addiction Services and Supports, said while specifics of the initiative must be ironed out, the plan has the opportunity to be a game changer in the opioid epidemic.

"It's a window of opportunity where people may be more amenable to starting treatment. Once they can get relief from their withdrawal symptoms, they may decide then to continue that treatment. It is very effective, not only in treating withdrawal symptoms, but in reducing opioid use and then reducing the risk of death," he added of buprenorphine.

For the past three legislative sessions, Assemb. Linda Rosenthal (D-Manhattan) has introduced a bill allowing paramedics to administer buprenorphine. Each time, the bill died in committee and never made it to the floor for a vote. Rosenthal said there was no outright resistance to the plan but rather it wasn't viewed as a priority by other lawmakers.

"The hope is this will save more lives," said Rosenthal, who reintroduced the bill earlier this month. " ... We need to break the cycle of overdose, Narcan, back on the street, need drugs and overdose again. And by administering buprenorphine, people can think about possible changes to their lives."

The bill doesn't have specifics of how the measure would be implemented, such whether paramedics would be required to get authorization from a hospital physician before administering buprenorphine in the field. Rosenthal said she would leave it to state regulators to work out the details.

One challenge in implementing the plan, some experts and treatment professionals say, is a statewide decline in the number of paramedics.

While calls for emergency assistance have grown in recent years, the number of EMS responders declined by 17.5% from 2019 to 2022, according to data from the New York State Department of Health Department's Emergency Medical Services Council.

Experts said administering buprenorphine also could increase the time paramedics would need to spend with some patients, making it more difficult to respond to other people in need.

'Part of the puzzle'

In 2019, Cooper University Health Care, a hospital and health care system in Camden, New Jersey, launched the nation's first pilot program equipping paramedics with buprenorphine during a time when the opioid crisis had peaked in the Garden State. 

Since then, the program has gone statewide and a host of other states have followed suit, including Florida, California, South Carolina, Delaware and Texas. 

Dr. Gerard Carroll, Cooper University Health Care's EMS medical director and a former paramedic, said data collected both in Camden and elsewhere, shows 25% to 35% of people who take buprenorphine from a paramedic following an overdose are in treatment for addiction recovery within 30 days.

But convincing people to take the medication isn't guaranteed, according to the physician. Only 8% to 10% of overdose victims whom paramedics assist agree to take buprenorphine, he said.

"When you look at the data on an overdose patient, one in 10 of them is dead in 12 months," said Carroll.

The physician added that helping even a small number of addicts with buprenorphine could save lives.

"It's not the solution, but it's definitely part of the puzzle," he said.

Jeffrey Reynolds, executive officer of Mineola-based Family and Children's Association, which provides addiction treatment services, agreed and said the governor's proposal could save lives on Long Island.

Reynolds said treating opioid abuse without buprenorphine, or other FDA approved medications that are used for withdrawal symptoms "is like trying to treat an infection without antibiotics. The sooner you start and the more support you can give a person in sticking to a prescribed regimen, the more likely they are to survive."