Thurston County EMS moves to pilot prehospital Suboxone and formalize peer follow-up with nonprofit partner

Thurston County Director of Emergency Services Ben Miller Todd told the Board of Health on March 11 that the county is finalizing protocols to deploy buprenorphine (Suboxone) from paramedic units and to expand leave-behind Naloxone distribution, and that a nonprofit partner will fund a peer case manager to support follow-up care.

Miller Todd said the state approved the county's pilot for prehospital buprenorphine on March 4 and that the county is in the final stages of training and protocol approval. “Suboxone is what's going to be used in the pre hospital setting throughout Thurston County and all of our paramedic units,” he said, adding that deployment was expected between April 1 and May 1 as training and approvals finish.

Why it matters: naloxone and buprenorphine are different clinical tools. Miller Todd explained to the board that buprenorphine binds opioid receptors with high affinity and a long half-life, which can reduce the risk of subsequent respiratory depression and reduce immediate mortality risk after an overdose. The county intends to use the medication as part of a broader linkage-to-care strategy rather than as a standalone treatment.

Catholic Community Services has agreed to fund a peer case manager to bridge the gap between a 2 a.m. field encounter and daytime clinic access, Miller Todd said. The peer will accept HIPAA‑compliant referrals and coordinate with treatment providers; the county will use Gelada (a HIPAA-compliant referral and case-management software) to send referrals from field crews to the peer and partner organizations.

Miller Todd also updated the board on broader system initiatives: the county anticipates an eighth Medic unit staffed in contract with the city of Tumwater with a targeted implementation date of Jan. 1, 2026 (possible earlier start if staffing permits). He said staff had completed the initiatives they committed to in 2024 and that protocol implementation and partnerships remain active priorities for 2025.

Board members praised the approach. Commissioner Fournier said the program was “forward leaning” and noted the mortality burden from overdoses. Commissioner Grant and others commended the inclusion of peer support; Grant said a peer with lived experience is uniquely capable of helping people connect to treatment immediately after an EMS encounter.

Staff said Gelada will enable a direct field-to-peer referral and that the peer case manager role is intended to fill a service gap between emergency care and daytime community resources. Miller Todd said the pilot will include training, HIPAA-compliant record-sharing and software workflows for referrals.

Ending: staff asked for continued board support as they finalize training, state approvals, software contracts and the peer-case-manager partnership. Deployment timelines for medication and referral workflows depend on finishing training and protocol paperwork and on the peer program hire and funding.