CORE Opioid Addition Recovery

Section 5 -MEDICAL

5.23 CORE Opioid Addition Recovery

These patients have suffered an opioid overdose or poisoning resulting in a decreased level of consciousness and near or complete respiratory arrest. Absence of consciousness/respirations have been treated by bystanders, law enforcement or EMS crew with naloxone (Narcan, Kloxxado, etc).

AFTER INITIAL MEDICAL CARE : PRECIPTIATED OPIOID WITHDRAWAL: Once the patient has received naloxone (Narcan/Kloxxado) and has had a recovery/return to consciousness and adequate respirations, they will likely be in a precipitated opioid withdrawal. The symptoms of opioid withdrawal include increased pulse rate, sweating, restlessness, tremors, anxiety or irritability, etc. The Clinical Opiate Withdrawal Scale (COWS) is an 11-item scale designed to be administered by a clinician, nurse, medic. This tool can be used to reproducibly rate common signs and symptoms of opiate withdrawal and monitor these symptoms over time. Note: The COWS exam is a tool, not a hard requirement for care.

Patients with signs of precipitated opioid withdrawal including increased pulse rate, sweating, restlessness, tremors, anxiety or irritability, etc. can be offered a safe way to start the recovery process and remove or significantly reduce opioid cravings and the precipitated withdrawal symptoms.

AGGREEMENT TO TRANSPORT AND TREAT WITH BUPRENOPHINE: Patients precipitated opioid withdrawal who agree to start recovery and agree to transport to a designated CORE transport facility with initiation of Buprenorphine treatment during transport as a safe way to start the recovery process. Patients MUST agree to the transport and transport must be started to receive Buprenorphine treatment to remove or significantly reduce opioid cravings and the precipitated withdrawal symptoms.

  START THE TRANSPORT AND TREAT WITH BUPRENOPHINE:

• ADMINISTER SUBUTEX 8mg ODT/Film orally. Pt encouraged to let the entire film/tab dissolve in their mouth (below the tongue) for maximum effect. Swallowing the tab will have little immediate benefit.
• Verify 1-2 times after administration that the ODT/Film is being dissolved appropriately and not being relocated for later diversion (selling) and/or not swallowed.
• RECHECK for signs of withdrawal/COWS score in 4-6 minutes.

If no improvement or inadequate improvement:

• ADMINISTER 2nd SUBUTEX 8mg ODT/Film orally. Pt encouraged to let the entire film/tab dissolve in their mouth for maximum effect.
• Verify 1-2 times after administration that the ODT/Film is being dissolved appropriately and not being relocated for later diversion (selling) and/or not swallowed.
• RECHECK for signs of withdrawal/COWS score in 4-6 minutes.

If no improvement or inadequate improvement:

• ADMINISTER 3rd SUBUTEX 8mg ODT/Film orally. Pt encouraged to let the entire film/tab dissolve in their mouth for maximum effect.
• Verify 1-2 times after administration that the ODT/Film is being dissolved appropriately and not being relocated for later diversion (selling) and/or not swallowed.
• RECHECK for signs of withdrawal/COWS score in 4-6 minutes.

MAXIMUM OF 3 SUBUTEX 8MG TABS DURING TRANSPORT.

• Pass on dosing and patient response to receiving facility.

TRANSPORT TO AN APPROPRIATE RECEIVING FACILITY FOR CORE PATIENT TRANSPORTS: These facilities have agreed to receive CORE patients treated with Buprenorphine and to continue care and stabilize as well as coordinate and navigate these patients to continued opioid addiction treatments including referring to an outpatient MAT provider, mental health support, peer counseling, transportation, housing and community paramedic support:

• Advent Altamonte.
• HCA Lake Monroe
• HCA Oviedo Medical Center.