Medicine | A paramedic was skeptical about this Rx for stopping repeat opioid overdoses. Then he noticed it assist.

Medicine | A paramedic was skeptical about this Rx for stopping repeat opioid overdoses. Then he noticed it assist.

Ocala, Florida
Tampa Bay Occasions/KFF Well being Information

Fireplace Capt. Jesse Blaire steered his SUV via the cell dwelling park till he noticed the little beige home with white trim and radioed to let dispatchers know he’d arrived.

There, Shawnice Slaughter waited on the steps, wiping sleep from her eyes.

“Good morning, Shawnice,” Blaire stated. “How are you feeling in the present day?”

“I’ve been good, I’ve been good,” Slaughter stated. “A lot better.”

Three days earlier, Blaire — a paramedic who leads the fireplace division’s emergency medical workforce — met Slaughter at a close-by hospital. She had overdosed on opioids. It took 4 vials of an overdose reversal remedy and dozens of chest compressions to get her respiration once more.

On the hospital, Blaire advised Slaughter a couple of free program that would assist. It wouldn’t simply join her with a restoration heart however would additionally get her medical doctors’ appointments, plus rides there. Extra essential, she would get medication to alleviate withdrawal signs so she wouldn’t seek for medication to ease the illness. Blaire would carry that remedy, day by day, to her dwelling.

“I’ve a son,” Slaughter, 31, advised Blaire. “I should be alive for him.”

Each morning since, Blaire had pushed over for a check-in. He reminded Slaughter of appointments and took observe of what she wanted: garments, meals, assist with payments.

And on the finish of every go to, from a lockbox at the back of his automobile, he disbursed to her a few tiny, lifesaving tablets.

These tablets — a drugs known as buprenorphine — symbolize a tidal change in the way in which counties in Florida and different states are addressing the opioid disaster. The concept: Get habit remedy to individuals who want it by assembly them the place they’re. Generally, that’s on the road. Generally, it’s within the driveway of a giant home with a swimming pool. Generally on the steps of a modest dwelling like Slaughter’s.


For a very long time, many individuals who may benefit from buprenorphine, generally recognized by the model title Subutex, couldn’t get it.

Till not too long ago, medical doctors wanted a federal waiver to prescribe it to deal with opioid use dysfunction. Amid misconceptions about treating opioid use dysfunction with remedy, solely about 5% of medical doctors nationally underwent the coaching to qualify. And in 2021, solely 1 in 5 individuals who may have benefited from opioid habit remedy had been receiving buprenorphine or one other drug remedy.

Ivy Ceballo/Tampa Bay Occasions/KFF Well being Information

Till not too long ago, medical doctors wanted a federal waiver to prescribe buprenorphine to deal with opioid use dysfunction.

However as proof supporting the drug’s efficacy grew and the urgency mounted to curb opioid deaths, Congress axed the waiver requirement in late 2022, clearing the way in which for higher availability.

And in uncommon circumstances, equivalent to in Ocala, medics on the entrance traces started bringing therapy to sufferers’ entrance doorways.

In Florida, the state-run Coordinated Opioid Restoration Community, referred to as the CORE Community, supplies tips on medication distribution to areas hit arduous by overdoses. Companies via the community are free for sufferers, funded by cash from the state’s opioid settlement.

The community appears totally different in every of its 13 counties. Not all hand-deliver buprenorphine. However the widespread purpose is to create a single entry level for providers which have usually been siloed and troublesome for sufferers to navigate, equivalent to psychological well being care and housing assist.

In a restoration panorama rife with shoddy amenities and prohibitive worth tags, simplifying the trail for sufferers stands to make a significant distinction.

“We all know that the extra individuals are in touch with providers, the extra they’re handled with respect, the extra probably they’re to cut back or stop drug use,” stated Susan Sherman, a public well being professor at Johns Hopkins College.

As opioid settlement {dollars} proceed to come back in, state officers have stated they hope to increase to extra counties.


Turning into a firefighter and paramedic happy Blaire’s yearning for adrenaline and his conviction, knowledgeable partially by his Christian background, that he was placed on this Earth to assist others.

At 20, he imagined responding to automobile crashes and coronary heart assaults, damaged bones and punctured flesh. However after years on the job with Ocala Fireplace Rescue, the calls started to alter.

At first, Blaire felt some resentment towards the individuals overdosing. His workforce was immediately responding to tons of of such calls a 12 months. He considered drug use as an ethical failure. What if a grandmother had a coronary heart assault or a child drowned whereas his workforce was on an overdose name?

Not like with different emergencies, he by no means actually felt he was saving a life when responding to an overdose. It was extra like delaying demise.

Time and again, he’d pump a affected person filled with naloxone, an overdose reversal remedy usually recognized by certainly one of its model names, Narcan, and drop them on the hospital, solely to search out they’d overdosed once more after being discharged. One Christmas, he stated, he responded to the identical individual overdosing 5 instances on a single shift.

“I didn’t perceive it. I assumed that they needed to die,” stated Blaire, 47. “I’m embarrassed to say that now.”

A couple of decade in the past, the scope of the epidemic had already come into full view to Blaire’s crew. It appeared the workforce was responding to overdoses at huge homes in rich neighborhoods almost as usually as they had been within the park and beneath the bridge.

One week, his workforce went to a house on a cul-de-sac with two children and a swing set — the form of place households take their youngsters trick-or-treating.

The dad had overdosed. The subsequent week, it was the mother.

“Cash can masks any downside, however we’ve seen it from the highest to the underside,” Blaire stated.

Over time, Blaire started to grasp habit because the illness it’s: a physiological change to somebody’s mind that traps them in a harmful cycle. Perhaps it began with a prescription painkiller after surgical procedure, or an indulgence at a celebration, however the majority of individuals weren’t utilizing medication to get excessive, he realized. They had been utilizing them to keep away from being sick.

“Think about the worst flu you’ve ever had, then make it so much worse,” Blaire stated.

When an individual depending on opioids stops taking them, their physique goes into withdrawal, usually accompanied by shakes, nausea, fever, sweating, and chills. Although uncommon, individuals can die from opioid withdrawal syndrome. Nonetheless, traditionally, the emergency well being care system has targeted on reversing overdoses, somewhat than treating the withdrawal unwanted side effects that preserve individuals returning to medication.

Prior to now, Blaire stated, he noticed sufferers launched from the hospital with little greater than a telephone quantity for a restoration heart. Getting an appointment may very well be difficult, not solely due to wait instances or insurance coverage issues, however as a result of the sufferers weren’t steady — they had been in withdrawal. To make it via the day, Blaire stated, they’d usually use once more.

“‘Good luck, you’re by yourself,’” Blaire stated. “That’s the way it was. And that doesn’t work for any person who’s sick.”

Below Blaire’s management, Ocala Fireplace Rescue sought to cease the revolving door by launching its Group Paramedicine program and the Ocala Restoration Challenge in 2020.

Ivy Ceballo/Tampa Bay Occasions/KFF Well being Information

A textual content message alternate by a former participant in Florida’s CORE program and Ocala Fireplace Rescue EMS Capt. Jesse Blaire.

They modeled it after overdose quick-response groups across the nation, which fluctuate in make-up. These cell groups, usually helmed by paramedics like Blaire, join individuals who have overdosed with providers aimed toward stabilizing them long-term. On some, a registered nurse embeds with paramedics in an ambulance or SUV. Others have a therapist or peer restoration coach on board. Some are bare-bones: a single responder with a telephone on 24 hours a day. Some get in contact with sufferers via a name or a house go to after a reported overdose.

Others, like Blaire’s workforce, intercept sufferers on the hospital.

Blaire likens the system to that of a trauma alert — a message despatched to medical facilities to prepared a response to near-fatal automobile wrecks or shootings. When a trauma alert goes out, working tables are cleared, CT scanners are prepped, and responders stand by for arrival.

“We set the identical system up for overdoses,” Blaire stated.

Now, when any person in Ocala overdoses, whether or not it’s on opioids, alcohol, meth, or cocaine, an alert goes out, notifying Blaire and his workforce, a peer restoration coach, a behavioral well being specialist, and a neighborhood restoration heart.

His workforce normally beats the ambulance to the hospital.

The subsequent day, workforce members observe up on the affected person’s dwelling.

Then, final Might, beneath the steering of the EMS medical director, Blaire’s workforce began providing habit remedy to opioid customers, too.

Since then, Blaire stated, his workforce has related 149 sufferers with therapy. Solely 28 of them have wanted extra intervention, he stated.


When Blaire first heard about buprenorphine, he was skeptical.

How may giving any person with an habit extra narcotics assist?

That widespread response misunderstands the fact of habit, stated Nora Volkow, director of the Nationwide Institute on Drug Abuse.

Individuals understand that one drug is being substituted for one more, Volkow stated. As an alternative, the usage of drugs like buprenorphine is extra akin to people who deal with different psychiatric circumstances, like temper problems or despair.

Analysis reveals that opioid habit remedy — together with medication like methadone — can tremendously scale back the danger of overdose deaths, and improve an individual’s retention in therapy. However a research out of the New York College Grossman College of Medication discovered that just about 87% of individuals with opioid use problems don’t obtain any.

Such habit drugs work by stimulating opioid receptors within the mind.

Opioids — like oxycodone or fentanyl — are what consultants seek advice from as “full agonists.” Think about an opioid receptor as a rounded bowl. A full agonist — like fentanyl — matches completely in that bowl and latches tightly to the receptor.

Buprenorphine is a “partial agonist.” It matches within the bowl — and satiates a craving — however doesn’t fully bind like a full agonist. As an alternative, it eliminates withdrawal signs so individuals received’t get sick or crave illicit medication, with out producing a excessive. Second, it counteracts the results of different medication, so an individual can’t overdose on different opioids like fentanyl or heroin whereas taking it.

And for any person who already makes use of opioids, overdosing from buprenorphine is sort of inconceivable.

“They assist an individual regain management of their on a regular basis life,” Volkow stated.


On this Monday in January, Blaire pulled into Beacon Level, a neighborhood therapy heart, simply previous 2 p.m.

He’d spent his morning calling on individuals like Slaughter, however now he was assembly paramedics from his workforce. After almost three weeks of dwelling visits, a person within the restoration community program was set to have his first appointment with a physician.

Blaire has discovered that after individuals are steady on buprenorphine, most of the time they need to get right into a therapy program.

Whereas Blaire waited, a girl strolling out of the middle approached, smiling.

“I simply obtained my first clear urine evaluation,” she stated. “I’m doing nice, I’m so excited.”

“That’s superior information,” Blaire stated, a smile stretched throughout his face. He’s usually stoic, straight-laced, with combed hair and aviators. However when he lights up, his all-business exterior provides technique to gentleness.

Jacqueline Luciano is sober for the primary time in 30 years. She’s proud, glowing, and Blaire is proud, too.

Ivy Ceballo/Tampa Bay Occasions/KFF Well being Information

Jacqueline Luciano, who began utilizing medication at age 9, says she has hope for the primary time.

Luciano first got here to Blaire via a referral when she was residing at a girls’s shelter. She stated she had $20 in her pocket and needed to get excessive — wanted to.

Fentanyl withdrawal had left her shaky and chilly. Her abdomen was seizing, her muscle tissue spasming. To quell the agony that day in early January, she went on the hunt.

Luciano stated she had first used medication when she was 9. Her household had been torn aside by drugs and powders, she stated, a illness she’d inherited.

However this time, a girl — “like an angel” — handed her a quantity for somebody who she promised may information her right into a brighter future, blame-free. Luciano, 39, paused, skeptical.

Then she gave Blaire a name.

For a couple of week, Blaire delivered her a day by day dose of buprenorphine utilizing a Protected RX bottle — primarily a trackable tablet bottle with a lock code to restrict who can open it. He helped join her with meals and clothes donations.

And as Luciano began to really feel extra like herself, absent of cravings, she started to hope.

Blaire obtained her an appointment with medical doctors at Beacon Level, then drove her to her first screening. Now, within the parking zone, she thanked him for every thing.

“It made all of the distinction on the planet,” Luciano advised Blaire. “I actually didn’t assume that I may get higher. I didn’t. However I’m.”

As a tear rolled down Luciano’s face, Blaire’s telephone rang.


The decision got here from the well being division. A person in his 40s or 50s had come some 40 miles from Gainesville, Florida, for assist, steered via phrase of mouth.

He’d tried to get right into a restoration heart there however stated he was turned away. One thing about insurance coverage and a prison file had stood in the way in which.

It’s a sample that drives Blaire loopy. He’d seen it so much earlier than his workforce was fashioned. Individuals would get a second of braveness or readability, solely to be advised “not but.”

“Your first reply must be ‘sure,’” he stated. “‘Sure, I may also help you.’”

He knew a couple of girl who had come from 25 miles out of city, then was advised to come back again days later. She didn’t have a automobile or a house to return to.

“They didn’t even provide her a journey,” Blaire stated. “Generally you solely have one shot.”

Ivy Ceballo/Tampa Bay Occasions/KFF Well being Information

Ocala Fireplace Rescue Capt. Jesse Blaire, proper, speaks with a person searching for therapy at Beacon Level, an built-in care heart for treating individuals with substance use problems in Ocala, Florida.

Blaire has discovered that constructing belief begins with a small providing. A automobile journey. A sandwich. Assist getting a authorities ID. Something to point out that you just care, that you just’re helpful. That you simply see somebody making an attempt.

Exterior the well being division, a person in muddied denims and a frayed T-shirt stood ready on the curb. He launched himself as Jetson and didn’t give a final title. Blaire shook his hand earlier than they loaded into the automobile.

“So what brings you this fashion?” Blaire requested, as soon as each had been buckled in.

“I heard there have been providers right here,” Jetson stated, his voice gruff, quivering. “I’ve tried to cease utilizing so many instances, however I preserve messing it up.”

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Jetson shook his head.

“Nicely, I’m glad you discovered us,” Blaire stated. He requested the person if he needed to go to the restoration heart for a screening. He did.

Over the 10-minute drive to Beacon Level, Blaire and Jetson talked, not about medication or meds, however life. Baseball. Cabbage (good when fried).

After they pulled up, Blaire handed Jetson a card.

“Please name me,” Blaire stated. “If you happen to want something. We will get you assist.”

For a second, the lads sat there. Jetson pulling at his fingers. Taking deep breaths.

Then, he obtained out of the automobile — Blaire’s card in hand — and walked via the glass door.

This text was produced via a partnership between the Tampa Bay Occasions and KFF Well being Information.

KFF Well being Information is a nationwide newsroom that produces in-depth journalism about well being points and is without doubt one of the core working packages at KFF—an unbiased supply of well being coverage analysis, polling, and journalism. Study extra about KFF.

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