An Analysis of Medications for Opioid Use Disorder (MOUD) Prehospital Programs Across North Carolina

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Abstract
Prehospital programs for Medications for Opioid Use Disorder (MOUD) have gained significant traction over the past few years. Data describing statewide implementation of MOUD programs are limited. Our objective was to describe the current practices within active prehospital MOUD programs in North Carolina and to compare these data with previously published best practices to assist in standardizing future MOUD programs. This was a cross-sectional study of 21 counties in North Carolina (NC) with an active prehospital MOUD program at the time of the study. Using virtual and phone interviews, counties were asked a set of predefined qualitative and quantitative questions related to their program structure and elements which were then analyzed using descriptive statistics and combined into a comparative format based on current best practice consensus recommendations. A total of 21 counties in NC had an active prehospital MOUD program, defined as having administered at least 1 induction dose. Of these active programs, 19 offered bridge dosing and 18 (86%) had administered at least 1 bridge dose. Inclusion criteria for patients were the same for all 21 active MOUD programs. In 20 counties (95%), only Community Paramedics (CPs) or other specialized personnel like EMS Supervisors were authorized to administer MOUD, while 1 county (5%) allowed any paramedic in the system to administer MOUD. With regards to induction therapy and the consensus recommendation of a 16mg dose, 9 counties (43%) utilized this dose for patients experiencing opiate withdrawal, and 13 (62%) counties used this dosing for patients experiencing withdrawal post overdose reversal with naloxone. Prehospital MOUD programs in North Carolina demonstrated broad consistency with only small variations with respect to dosing, funding sources, hours of available treatment, and team composition. This study demonstrated significant consistency with regards to the approaches of NC EMS systems in the care of OUD, providing replicable models other states can use to drive forward prehospital MOUD programs and create a national standard of care. Further studies are needed to link these efforts to associated patient centered outcomes.

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