Novel Program Smooths Path to Recovery for Opioid Addiction

The rescue drug Narcan is the end of one nightmare, but often the beginning of another. While the lifesaving medication immediately blocks the opioids that suppress the breathing of the person having an overdose, it also brings on severe withdrawal symptoms.

Fortunately, the medication buprenorphine can dull the intense cravings, headaches, anxiety, nausea and pain associated with withdrawal. However, in most of the country, people have to endure an excruciating ambulance ride and long wait in an emergency room before, and if, they can get that relief.

In Contra Costa County, that is no longer the case. Thanks to a pilot program launched by Contra Costa Health in 2020, Emergency Medical Services (EMS) can now administer buprenorphine in the field, offering immediate relief and setting people suffering from addiction on a smoother, more humane path to recovery. It’s all part of a comprehensive approach the Contra Costa Health has undertaken to fundamentally rethink how to structure care and treatment for people with addiction.

Paramedic Dubravka Frost remembers one person who was very aware that she was going through withdrawal and wanted to get to a hospital so she could get buprenorphine. “I told her that I could actually help her there and then,” Dubravka said.

“The patient was very thankful and a little shocked that we could end her suffering right on the spot.”

Stabilized and receptive to further care, people begin their treatment journey. Most people who received buprenorphine are transported to Contra Costa Regional Medical Center, a designated opioid-receiving center equipped with trained, nonjudgmental staff and a culture that allows for a higher continuance of medication use.

Public Health Substance Use Navigator Tambra Divine is at the door when the patient arrives. In fact, every person in the county who was treated by EMS for opioid issues hears from Tambra. “I introduce myself and start building rapport right away. I let them know that we’re here to help, that our healthcare system offers them options.”

In the quiet privacy of a hospital room, Tambra takes her time guiding people through the next steps. She introduces the Choosing Change clinic, a comprehensive Contra Costa Health program that combines medication, group therapy and medical support for opioid use disorder treatment. Interested people are set up with an initial consultation and provided with the buprenorphine they need to see them through that appointment. After discharge, Tambra checks in regularly, following up at seven, 14 and 30 days.

Tambra handles each case with compassion, offering support both to people who are lifelong opioid users and those who unknowingly ingested opioids from contaminated substances. For Tambra, it comes down to helping families avoid the heartbreak she experienced when she lost her nephew to a fentanyl overdose.

“That’s what drives me every day,” she says. “That’s what fuels my passion.”

At Choosing Change, people move to a new phase of treatment. The program assesses people’s needs on a case-by-case basis, helping them set realistic goals. “We look at substance use, and specifically opioid use, as an ongoing disease process,” says Public Health Nurse Program Manager Phoebe Blaschak Olivera. “For people with substance use disorder, stability ebbs and flows. That’s why long-term medication is essential.”

Professionals from all corners of the healthcare system come together to support program participants. Mental health providers oversee a series of medical group visits, fostering valuable conversations among patients. Doctors and nurses cut through pharmaceutical red tape to secure patients’ access to buprenorphine. An interdisciplinary team of community health workers handles all the headaches of scheduling appointments and interfacing with insurance companies.

Primed by a positive first interaction with EMS, people are more likely to take advantage of this wider system of care. Dubravka looks forward to updates on the people she provided with buprenorphine.

“We see these patients at their lowest, so we appreciate knowing they’re doing better,” she remarks. “It’s nice to know that we were the first ones to help them move in that direction.”

Contra Costa County is among the first in the nation to implement this first-responder EMS model for treating patients with opioid use disorder, serving as a successful model for similar interventions across the state and country.

Thanks to the collaboration between Public Health, CCRMC and EMS, lives are being saved and needless suffering is reduced. According to Phoebe, “All these different programs come together so there is no break in the chain of treatment and recovery.”