Opioid overdose survivors revived with naloxone often experience severe withdrawal symptoms and may refuse transport to hospital and opportunities to access further treatment. Started in 2019, the innovative Bupe FIRST program (Buprenorphine Field Initiation of Rescue Treatment by EMS) equips ambulances with high-dose buprenorphine for overdose victims. Buprenorphine reduces the severity of opioid withdrawal and research indicates that providing it immediately post overdose increases a patient's willingness to access additional addiction services. EMS workers are trained in buprenorphine administration and techniques to promote patient acceptance of the medication and agreement to follow-up care. Patients are offered same-day or next day appointment opportunities at an addiction treatment facility. 

The overall impact of Bupe FIRST is to increase engagement with the treatment system for those with opioid use disorder by providing them with pre-hospital access to high-dose buprenorphine at the site of an overdose. Increased entry into long-term treatment, in particular modalities involving medication for opioid use disorder (MOUD), reduces the chances of a later, possibly fatal, overdose. An overview of the program, the first of its kind in the US,  cites the relevant research literature, and news coverage is available here and here. As described in this report, San Francisco initiated a similar program in 2023. A 2021 study describes state and federal legal regulations on providing buprenorphine which may affect a jurisdiction's ability to replicate Bupe FIRST. 

There is similar EMS buprenorphine program in North Carolina with promising evidence for initiating and retaining people on this life-saving medication.