Stomping through stubborn, crunchy January snow, Dr. Jennifer Pierce made her way recently to a new Anchorage Fire Department vehicle. It might look like a simple SUV, but it’s equipped as a new mobile unit that – for the first time – will allow emergency responders to administer buprenorphine on-site, which can help get patients on the road to recovery.
“We want people to see us as a beacon of help,” Pierce said.
Pierce is on a mission: to treat Anchorage residents who overdose and connect them with care afterwards. After being treated for an overdose, many patients don’t agree to further treatment at the hospital or emergency room. Working out of mobile units allows the team to meet those Alaskans where they are.
“We don't want people to fall through the cracks,” she said.
Narcan, or naloxone, is used to reverse overdoses. But it puts people into immediate and uncomfortable withdrawal. Research shows that in similar mobile programs, offering that second medication, buprenorphine, makes it more likely patients will enter long-term recovery. Even if people don’t continue treatment, Pierce said, the medication can help them make it through a critical window when overdose survivors are at high risk of dying.
“Even if it's just one life,” she said. “We're saving lives out there and preventing individuals, maybe from overdosing the next day or overdosing again later and dying.”
Pierce visited successful programs in Texas and Washington state for ideas and best practices to replicate in Alaska.
The Anchorage team can get dispatched by 9-1-1 when someone is experiencing an overdose. During slower parts of their shift, they’ll be able to do treatment outreach with people who are at higher risk of overdose, Pierce said.
Offering patients buprenorphine has several benefits, said Seth Workentine, an addiction medicine specialist in Juneau who consulted for the pilot program there.
Buprenorphine lasts much longer than Narcan, at least 24 hours, protecting people from re-entering overdose. It also reduces withdrawal symptoms, which can push people back to opioid use, Workentine said.
“Withdrawal is an extremely uncomfortable experience hated by almost everyone who's ever experienced it and is often a barrier to people seeking treatment,” he said. “Now they just feel normal and have a much bigger leg up into entering recovery.”
But buprenorphine is an opioid, and Workentine said he’s heard critics of similar programs argue that it’s just swapping one drug for another. That’s not the case, he said, because buprenorphine is different and, over time, it actually helps reverse the brain changes that happen with addiction.
“So it's not replacing one for the other, even though they're in the same category,” Workentine said. “It is actually part of healing you.”
And that, he said, is integral to the recovery process.
Dr. Quigley Peterson, an emergency room physician heading Juneau’s pilot program, said he’s also seen the healing benefits of buprenorphine. He’s confident the pilot will do well partly because he’s seen how helpful the medication can be in a different setting: the emergency room.
“We have something that can help engage people, that's super safe and it's cheap, and it works,” Peterson said.
The pilot programs will collect data over the year to see what happens to patients after they’re given buprenorphine for an overdose, Peterson said. His hope is that it reduces emergency room visits and calls for emergency medical care. That would be good for the mental health of emergency responders, too, who get burnt out responding to the same patients over and over, he said.
If you can get patients into long-term care, Peterson said, “you won't need to see them in the future. You won't have these recurrent EMS calls.”
If the pilot programs are successful, Peterson’s goal is to inspire similar programs in more communities across Alaska.
