College of Pharmacy alumna Dr. Holly Drone is tackling the opioid crisis systemically. As a clinical pharmacist in emergency medicine and in Hennepin Emergency Medical Services (EMS), she co-leads a team of six paramedics specially trained in caring for patients who have overdosed or live with opioid use disorder. Drone says the team was “born from a need in the community to bridge patients from emergency care to community care.”
This EMS model has been up and running since this past spring and is currently funded through the federal Overdose Data to Action grant, which is intended to increase low-barrier access to medications for opioid use disorder.
Several hospitals are working on something similar, but the emergency department at Hennepin Healthcare already treats a large proportion of patients with opioid use disorder in Minnesota, so the team is shifting focus to the “pre-hospital space,” meaning what happens before a patient is transported to the hospital.
This includes supplying 911 trucks with suboxone (a combination of buprenorphine and naloxone) to administer immediately post-overdose — before an outreach team works on supporting patients in the following weeks. Drone says the team follows up on referrals from the clinic, emergency department, jail system and community partners.
“They're able to meet patients where they're at — whether it's a homeless encampment, the library, their apartment, their mom's house — and actually treat them in their space,” Drone says. “If it happens to get people started on the pathway to treatment, then that's amazing…
“We're taking the next step — what does day two look like for people? Or next week? Do they need social support? Do they have food on the table? Sometimes it's a lot later that people are ready to connect with other services or think about the next step in their journey.”
A model for rural and urban communities
Drone’s team is one of the first to attempt what she calls “the two-pronged approach” of supplying emergency vehicles with suboxone first and conducting follow-up services later.
“We're hoping we can prove that this is a worthwhile and feasible model for emergency medical services in various areas. I think it has a huge role in the rural areas, where access to clinics is much harder than in the Twin Cities,” Drone says. “We’re working alongside harm reduction teams and community health workers to build a more seamless system that meets people where they are … and connects them to ongoing support.”
Drone was drawn to EMS in particular because “they’re a very nimble group” with only a specific set of medications on hand, which they use in particular ways and in the hardest of places, she says. She says operations, purchasing groups, pharmacists, paramedics, and their medical directors are working in “different worlds,” which often breeds miscommunication.
“[Paramedics] are in someone's living room wedged between a bed and a wall doing a cardiac arrest, [for example], and that's something that’s really hard to understand when you're not working in that space,” Drone says. “I was able to start speaking the language between the [various] groups, which was super key. Everyone wanted to help each other, but they weren't speaking the same language.”
So far, Drone’s EMS team has mostly treated patients who have already interacted with the Hennepin Healthcare system in some capacity, though they’re beginning to receive referrals from community partners for patients who haven’t. They’re also piloting a partnership with YourPath, a telehealth platform for those recovering from substance use issues, to see if more patients connect to the resource when referred by paramedics.
Most recently, Drone and her team launched MN Bridge, a web resource for EMS agencies on more effective methods of engaging with the opioid crisis — stocking their ambulances with naloxone kits, educating paramedics on stigma, creating a training program for using buprenorphine in 911 services, etc. — that compiles research, articles, template protocols and training materials into one platform. On top of that, the team is presenting data from their emergency responses at discussion groups around the state to help spread awareness about this approach.
“This isn't something that you necessarily learn in school — how to do these things that are a little bit bigger than direct patient care,” Drone says. “It's been a really rewarding and unique opportunity to spend time doing both patient care and being able to hopefully start affecting things on a system level, because these big systemic problems can feel so overwhelming when you're just doing your day-to-day work.”
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