Opioid Addiction Treatment Delivered on the Front Lines

When paramedics revive someone from an opioid overdose, they often face a familiar scene: the patient, groggy, cranky, and sick to their stomach from withdrawal, refuses additional care and walks away, sometimes right back into harm.  

But in Wake and Durham counties, Duke Health emergency medicine physicians Andrew Godfrey, MD, and Anjni Joiner, DO, MPH, are leading a shift in how health care systems respond to these moments.  

Equipped with the medication buprenorphine, emergency medicine services (EMS) teams are now offering immediate addiction treatment to overdose survivors in the field before they reach a hospital.  

The approach reimagines EMS as more than a lifesaving force in the moment, but as a first step toward recovery for people with opioid use disorder — a disease that, without treatment, makes people much more likely to die from an overdose.

In fact, their risk of a fatal overdose is more than eight times higher than for people who are in treatment.  

“This isn’t just about prescribing medication,” said Joiner, associate professor and chief of the EMS division in the Department of Emergency Medicine at Duke University School of Medicine and medical director for Durham County EMS. “We’re not only saving lives in the moment; we’re giving people a chance to get their lives back.”  

A Crisis, and a Missed Opportunity

Every overdose reversed is a narrow escape. But for many patients, that’s where the help ends. Without immediate access to rehabilitation, they often spiral into repeated overdoses and too often death.  

“Buprenorphine changes the dynamic,” said Godfrey, assistant professor in the Duke Department of Emergency Medicine and associate medical director of Wake County Emergency Medical Services. “It not only prevents overdose for up to 24 hours, but it also eases withdrawal symptoms, giving up a chance to talk about treatment.”  

Godfrey led a study evaluating the first year of Wake County’s pilot program, which began equipping EMS teams with buprenorphine in May 2023.

He found that among those who received the medication, about half successfully connected with outpatient addiction care, and seven remained in treatment a year later. No severe adverse events were reported.

That success has encouraged rapid expansion. Durham County followed suit, launching a parallel program that trains every paramedic — on every ambulance — to identify eligible patients and administer buprenorphine in the field.  

The strategy is targeted at individuals who might otherwise slip through the cracks of a health system they rarely engage with outside of 911 calls.  

“This program was built out of filling that gap — meeting patients where they are, wherever they feel safe,” said Joiner, who leads Durham County’s EMS Medication for Opioid Use Disorder program. “EMS can be a bridge for patients who aren’t going to engage with the health care system otherwise.”  

That bridge includes more than medication.

Paramedics also hand out naloxone kits that contain the fast-acting drug that reverses opioid overdoses — to patients, families or bystanders — as a harm reduction measure for those not yet ready to enter a rehabilitation program.  

Medications for opioid use disorder are saving lives and now more emergency rooms and some jails are offering them. New research shows that providing treatment in Massachusetts jails lowered overdose deaths and non-fatal overdoses after release. North Carolina is leading the way with care that starts in the pre-hospital setting.

Since its launch Durham County’s program has treated 81 unique patients. The program has also drawn interest from neighboring counties, helping to fuel a statewide shift:  as of this year, about 20 EMS systems in North Carolina now offer similar care. 

A New Role for EMS 

The shift reflects a broader reframing of EMS’ role in public health, said Joiner, a national dialogue she is helping to advance, one that moves beyond flashing lights and urgent calls and towards long-term recovery and community intervention.  

While Durham’s overdose death rate — 23.9 deaths per 100,000 residents — is slightly below the North Carolina average of 27.7, the state remains in the grip of a deadly epidemic. In Wake County alone, more than 1,300 overdoses were reported during the study period.  

Against that backdrop, Godfrey believes programs like Wake’s offer more than just medical intervention. They offer hope.  

“Opioid use disorder is a big disease,” he said. “Broadly we’re making progress with the availability of naloxone, public awareness campaigns, buprenorphine, and other actions. This is another tool in our armamentarium to help patients who might otherwise slip through the cracks.”  

Liz Switzer is communications strategist for the Duke University School of Medicine Department of Medicine.  

Photography by Eamon Queeney assistant director of multimedia and creative for the Duke University School of Medicine Office of Strategic Communications.