Board backs recommendation to City Council for prehospital buprenorphine pilot

The Board of Health voted to recommend that the City Council fund a pilot to allow prehospital buprenorphine administration following naloxone for appropriate patients. Presenters described a protocol tied to clinical screening (COWS score) and a handoff pathway to Lowell General and the Bridal Clinic for same-day follow-up.

The EMS presenter told the board that although local overdose counts were down in June, the risk of sudden spikes remains and the pilot aims to reduce immediate withdrawal and improve engagement with treatment after resuscitation. He said funding for start-up would come from Massachusetts opioid abatement settlement funds and that Lowell would seek City Council approval to use its abatement allocation.

Clinicians stressed safeguards. One physician presenter explained that state protocol updates emphasize COWS assessment before starting buprenorphine: "you should not get buprenorphine until you meet an appropriate COWS score. Most agencies are going to say at least a score of 8 or greater." Audra Williams, medical director at the Bridal Clinic, said the approach leverages a narrow clinical window after naloxone: "we feel so comfortable encouraging people to try buprenorphine at this moment because Narcan has already lifted off the fentanyl from the receptors." She described a plan to provide a three-day buprenorphine kit at ED handoff and recovery-coach follow-up to ensure patients enter addiction treatment services.

Board members asked about dosing, controlled-substance tracking and long-term funding; staff said the board's role was to recommend the pilot and the City Council would ultimately approve use of abatement funds. After discussion, a board member moved to support the project and recommend city funding; the motion was seconded and the board approved the recommendation by voice vote.