First responders in Clark County can now administer a medication to treat opioid-use disorder through a statewide pilot program.
The Washington State Department of Health has partnered with counties across the state to launch a program that allows first responders to administer buprenorphine. The medication stabilizes patients experiencing withdrawal — common after Narcan is administered — and treats opioid-use disorder in the long term.
“It’s something EMS physicians have been talking about for some time. This is really the key,” Clark County EMS Medical Director Marlow Macht said. “What we do every day is respond to calls. What’s new with this is that the goal is to administer the first dose of medication, but then create that warm handoff into treatment.”
Clark-Cowlitz Fire Rescue, headquartered in Ridgefield, is the first department in the county to participate in the program, which began Oct. 1.
In administering buprenorphine, first responders will talk with patients about next steps, including permanent treatment options, recovery, mental health and other social services.
Buprenorphine, which is taken orally, can be administered only by paramedics and requires special training.
Macht said he anticipates the program will expand to more departments in Clark County within the next couple of months. The county has a total of 300 paramedics and 500 emergency medical technicians.
“The reason we’re starting small is that we want to demonstrate that we’re not just giving people a dose,” he said. “We want to work through those hurdles on a small scale and develop those paths to get people into treatment.”
Responding to the call
The Clark-Cowlitz Cares Team, started by Clark-Cowlitz Fire Rescue, is officially stocked with doses of buprenorphine.
The two-person Cares Team includes a paramedic and mental health specialist who can respond to calls dealing with overdoses, suicide attempts and other mental health crises.
There are multiple steps to treating overdose patients, who are often unconscious when first responders arrive.
They start by administering Narcan, which immediately reverses the effects of an overdose.
But a patient will often begin to experience intense, painful withdrawal symptoms shortly after. That’s where buprenorphine comes in. The medication simultaneously helps alleviate those symptoms and acts as the first step to treatment for opioid-use disorder.
Cares Team Program Manager Sam Lewis said the fire department has partnered with Rainier Springs, Ideal Option and Carelon — three addiction and mental health treatment centers in Vancouver — to link patients with long-term treatment options after an overdose.
“We’ve done a lot of groundwork ahead of time to really look at what programs are going to be best to fit each individual we come across, depending on availability, insurance and location,” Lewis said. “It’s really symbiotic with everyone working together. We see better results with people getting into recovery when they start right away.”
Buprenorphine requires long-term use to effectively treat opioid-use disorder. But by providing the initial dose, first responders can have more productive, meaningful conversations to ensure that a patient gets the help they need, Assistant Fire Chief Mike Jackson said.
“We can release those initial response resources, the ambulance and fire engine, to get them back in service for other calls, while our team can stay on scene for whatever time is needed to connect with a patient,” Jackson said.
National crisis
Clark County is experiencing the highest number of drug overdose deaths in decades, driven by the production and trafficking of synthetic opioids such as fentanyl and methamphetamine, according to Clark County Public Health.
In 2023, EMS responded to 890 opioid overdoses in Clark County. That year, 160 people died of a drug overdose. Between 2018 and 2023, the opioid crisis killed 9,251 people in Washington.
“The key thing to communicate is that opioid-use disorder is a brain disorder. There’s a lot of stigma in society that views it as a personal weakness, but we wouldn’t tell a diabetic, ‘Don’t take insulin; it’s a personal weakness,’” Macht said.
Buprenorphine is only the first step. Recovery for addiction works best when paired with therapy and other resources, but it’s not always that easy.
“The disease itself doesn’t want you to heal,” mental health professional Shahna Craegan said. “It’s not a conversation we can really even hold if they’ve just had Narcan. Then they get the buprenorphine and they start to feel a little better, which then builds trust with us as community response people in their space.”
In total, seven Washington counties have joined the pilot program, including King, Clallam, Spokane, Snohomish, San Juan and Whatcom.
The Seattle Fire Department has already given 39 doses of buprenorphine. Seattle plans to expand the pilot program to include emergency medical technicians, according to a news release from the Washington State Department of health.
“The Department of Health is determined to help Washingtonians live healthy and fulfilling lives, and to stop this opioid crisis from robbing those lives from our neighbors, friends, and family members,” Secretary of Health Umair A. Shah said in a news release. “This pilot program will help us reach that goal and will put critical care closer to the people who need it most.”
