To help firefighters prevent overdose deaths, make treatment more available
American fire and EMS personnel are on the front lines of combatting the overdose crisis, helping to save thousands of lives every year. In fact, nearly two-thirds of all firefighter rescues aren’t for fires but for medical emergencies , many of them drug overdoses. Firefighters, paramedics, and emergency medical technicians (EMTs) are routinely trained to administer naloxone — a medication that reverses an overdose. Naloxone administration through firefighter rescues has proven to be lifesaving, and firefighters have successfully reversed 82 percent of overdoses they encounter. Overdose prevention is one of many ways we can give people another chance at finding recovery.
While first responders can successfully prevent fatal overdoses using naloxone, we do not have to wait until a person overdoses to send help — there are evidence-based approaches to prevent overdoses before they happen. Medications to treat opioid use disorder (MOUD) have been shown to significantly reduce the risk of overdose death.
Despite this demonstrated success, only 11 percent of people with opioid use disorder received MOUD in 2020, partly due to outdated federal regulations that stand in the way of broader access to MOUD. With nearly 108,000 people across the country dead from an overdose in 2021, we must use every option available to reduce overdose deaths.
One FDA-approved MOUD, buprenorphine, has been proven effective at preventing overdose and safe enough to be prescribed by health care providers and taken at home. Access to this medication is critical for the more than 2.7 million Americans with opioid use disorder. Yet burdensome federal regulations not only narrow the pool of eligible health care providers who can prescribe buprenorphine to those who obtain a special waiver (known as the x-waiver) from the DEA, but also limit the number of patients each waivered provider is allowed to treat.
The U.S. Department of Health and Human Services reports that 40 percent of counties in the United States — many of them rural — do not have a single buprenorphine prescriber, leaving many rural Americans without access to this lifesaving treatment.
The imbalances in buprenorphine access extend beyond geography. Black and Latinx Americans have seen startling increases in overdose death rates, but are less likely to have buprenorphine providers in their own communities. Veterans are 1.5 times more likely to die of an opioid overdose than the general population, but fewer than one in three receive buprenorphine for opioid use disorder, despite recent evidence that it greatly reduces the risk of suicide among veterans.
In June 2022, the U.S. House of Representatives passed a comprehensive mental health package containing the Mainstreaming Addiction Treatment (MAT) Act, which would remove the x-waiver requirement to prescribe buprenorphine. The next step lies with the Senate. The Senate must pass a similar bill that includes language that would eliminate the x-waiver. In taking this key action, the Senate can increase access to treatment, decrease overdose deaths, and reduce stigma.
It is also important to remember that fire and EMS personnel are not immune to the stresses and trauma the COVID-19 pandemic and overdose crisis have wrought. A significant number of overdose calls that require fire and EMS response are repeat patients. Due to the nefarious nature of addiction, a person suffering from opioid addiction can be treated with an emergency dose of naloxone and then succumb to the symptoms of withdrawal within hours. These repeat overdoses create constant strain on fire and EMS providers that already must deal with workforce shortages and longer hours as a result of the COVID-19 pandemic.
For those fire and EMS personnel who develop mental health challenges and substance use disorders in response to these stressors, increased access to substance use treatment will help. More people getting treatment also means that fire departments will have fewer calls for emergency medical care, relieving some of this stress.
Every day, firefighters, EMTS, and paramedics work to keep our communities safe, and in the current era, that means recognizing and reversing drug overdoses so people can have another chance at life and recovery. The Senate has a chance to help people struggling with drug dependence get the treatment they need and help firefighters and other first responders do a better job preventing overdoses — they must pass the MAT Act to make sure people can get treatment before it is too late.
Chief Donna Black is the President and Board Chair of the International Association of Fire Chiefs (IAFC). She began her fire service career in 1997 as a volunteer, earning her way through the ranks (as both a paid and volunteer firefighter), culminating in 2006 when she was selected as the fire chief for the Town of Duck. Libby Jones is the project director of the Overdose Prevention Initiative at the Global Health Advocacy Incubator (GHAI). Libby leads the Initiative’s advocacy efforts, advancing federal policies to reduce the overdose death rate in the United States by expanding access to treatment and promoting harm reduction.
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