San Francisco Fire Launches Prehospital Buprenorphine Program to Combat Opioid Epidemic

Effort builds on Department of Public Health’s work to expand access to buprenorphine -- which reduces deaths due to opioids, opioid cravings and withdrawal symptoms
March 31, 2023

San Francisco, CA – Today San Francisco launched a new program to expand buprenorphine distribution by emergency responders as part of the City’s efforts to reduce opioid overdoses. Buprenorphine helps reduce opioid withdrawal and cravings and, along with methadone, is the most effective treatment for opioid use disorder, reducing the risk of overdose fatalities by up to 50%.    

Under this new initiative, emergency personnel from the San Francisco Fire Department (SFFD) will administer buprenorphine in the field prior to taking individuals to a hospital, expanding access to support patients who are experiencing opioid withdrawals. The program starts April 1.   

This effort builds on the San Francisco Department of Public Health (SFDPH) work to expand access to buprenorphine citywide, through a range of programs and services. This includes at hospitals and clinics, SFDPH Community Behavioral Health Pharmacy, shelters and navigation centers, jail, by delivery in City permanent supportive housing, and other settings.   

"Expanding access to life-saving medication is a critical part of our work to prevent overdoses,” said Mayor London Breed. “By giving our emergency responders the training and ability to deliver buprenorphine in the field, we can reach more people more quickly. This is part of our broader strategy to ensure that our public health workers and emergency responders have as many tools as possible to save lives.”  

For years, the prescription of buprenorphine was heavily regulated, which prevented emergency responders from being able to administer it in a prehospital setting. In December of last year, President Joe Biden signed the Consolidated Appropriations Act, 2023 which relaxed federal regulations to grant more medical professionals the ability to prescribe this treatment, which like methadone reduces the risk of death by 40-50%. This change in regulations allowed the City to launch this new program by SFFD.  

“Last year, under the leadership of President Joe Biden, the Democratic Congress made it easier for medical professionals to save lives from opioid overdoses on our streets,” Speaker Emerita Nancy Pelosi said.  “This new initiative, made possible by our Congressional action and launched by the San Francisco Fire Department, will expand treatment efforts for opioid use disorder and slash the risk of overdose fatalities in half – an important step in addressing the opioid crisis that has devastated families and strained our health care system.  Let us salute the leadership of Mayor London Breed and our City’s public health officials and first responders for their tireless work to protect the safety and well-being of all San Franciscans.”  

“Every day, our first responders are working on the front lines of the overdose epidemic,” said Fire Chief Jeanine Nicholson. “We know that pre-hospital buprenorphine can save lives, and I’m proud of the collaborative effort between City Departments that provided this important tool to our paramedics and our community.”   

“The Department of Public Health is strongly committed to increasing access to buprenorphine because it is an effective treatment for substance use disorder,” said Dr. Grant Colfax, Director of Health. “The City’s efforts to expand access to this vital medication will help save lives.”  

The program will be implemented in partnership with local emergency medical services (EMS) and addiction treatment providers. EMS personnel will receive training on the administration of buprenorphine and how to connect patients with addiction treatment resources. Emergency responders are often the first on the scene of an overdose, and the ability to administer this treatment in the field can make an immediate and meaningful difference for those grappling with addiction.   

"By providing emergency responders with the tools and training necessary to administer buprenorphine in the field, we can save lives and connect individuals struggling with addiction to the resources they need to achieve lasting recovery," said Dr. Jeremy Lacocque, SFFD’s Medical Director.  

“The addition of buprenorphine required state approval to expand the paramedic scope of practice, additional local training, and policy development with EMS partners. We’re excited that paramedics will have this additional training in the City and County of San Francisco, which will ultimately save lives,” said Andrew Holcomb, County EMS Director.  

Under SFDPH’s leadership, twice as many people are receiving buprenorphine treatment since 2013 and three times as many people since 2010. More than 3,100 people in San Francisco received this treatment for opioid use disorder in 2021.    

Expanding access to buprenorphine is part of the City’s Overdose Prevention Plan, which aims to reduce fentanyl and other drug-related deaths, increase access to treatment for opioid use disorder (including addiction to fentanyl) and stimulant use disorder, increase social support for and reduce the stigma experienced by people at risk of overdose, and improve the community conditions in which drug use occurs.