The Journal of emergency medicine
September 23, 2026 · via Europe PMC
Emergency Department-Administered Extended-Release Buprenorphine After Fentanyl Overdose Reversed by Emergency Medical Services With Naloxone.
Bascombe K, Patregnani M, Gubac D, +5 more, Herring AA.
AI summary — for doctors, generated from the abstract only
A case showed extended-release buprenorphine was given in the ED after an EMS naloxone reversal of fentanyl overdose.
What was studied
Case report of a 30-year-old man reversed with intranasal naloxone, in withdrawal (COWS 22), who received EMS sublingual buprenorphine and then ED XR-buprenorphine.
Key findings
- Naloxone 8 mg was given.
- The patient was assessed in opioid withdrawal.
- The XR-BUP aimed to improve linkage to care.
Clinical relevance
Early buprenorphine after overdose may reduce repeat overdose.
Who should care
Limitations
Single case with outcomes not given in the abstract.
Consider starting buprenorphine in the ED after overdose reversal.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
Emergency Medical Services (EMS) providers are on the frontline of the opioid epidemic and administered naloxone to reverse suspected overdose over 442,000 times in 2024. Interest in EMS-initiated sublingual (SL) buprenorphine (BUP) exists; however, initiation of month-long extended-release buprenorphine (XR-BUP) in the immediate postoverdose period has not yet been described. The high risk of death from repeat overdose in patients with opioid use disorder (OUD) could be reduced by administration of XR-BUP. The purpose of this case report is to highlight the utility of EMS-initiated SL-BUP followed by XR-BUP to potentially improve care linkage and adherence to medication-assisted OUD treatment.
Case report
A bystander call to 911 dispatched a Basic Life Support (BLS) unit to an unresponsive 30-year-old man found with fentanyl-smoking paraphernalia. First responders administered 8 mg of intranasal naloxone. Paramedics arrived 8 min later and assessed the patient to be in opioid withdrawal with a Clinical Opiate Withdrawal Scale (COWS) score of 22. The patient reported using heroin or fentanyl and methamphetamine daily. After consent, paramedics administered 16 mg of SL-BUP. In the ED, an addiction medicine consult service administered a 300-mg monthly XR-BUP formulation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We report that rapid transition from naloxone reversal of overdose and EMS initiated SL-BUP to month-long XR-BUP is possible during a single emergency medicine encounter using a stepwise clinical pathway. We hope our observations encourage further prospective study of the intervention described as this may link patients to medication assisted OUD treatment, which decreases mortality in patients with OUD.
DOI
10.1016/j.jemermed.2026.09.011
PMID
42896403
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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