Dr. Aaron Burnett, medical director for Regions EMS and the St. Paul Fire Department, and SPFD assistant chief Steve Sampson discuss how their teams are confronting the opioid crisis on St. Paul streets. They share how a new program using Suboxone helps first responders treat opioid use disorder more effectively and compassionately. With a focus on community trust, collaboration and meeting people where they are, this conversation highlights the power of innovation in the public health response.
Dr. Aaron Burnett, medical director for Regions EMS and the St. Paul Fire Department, and SPFD assistant chief Steve Sampson discuss how their teams are confronting the opioid crisis on St. Paul streets. They share how a new program using Suboxone helps first responders treat opioid use disorder more effectively and compassionately. With a focus on community trust, collaboration and meeting people where they are, this conversation highlights the power of innovation in the public health response.
Hosts: Kari Haley, MD, and Steven Jackson, MD
Guests: Aaron Burnett, MD, and Steve Sampson
HealthPartners website: Off the Charts podcast
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Kari Haley:
He's a rehab doctor from Chicago.
Steven Jackson:
She's an emergency medicine doctor from the Twin Cities.
Kari Haley:
Together, we're examining the health equity emergency.
Steven Jackson:
Inviting voices for change without the cue cards.
Kari Haley:
I'm Dr. Kari Haley.
Steven Jackson:
I'm Dr. Steven Jackson.
Both, together:
And this is "Off the Charts."
Kari Haley:
Welcome to the show, and another great episode of "Off the Charts." Unfortunately, my colleague, Dr. Steve Jackson, is not here today, but I have two amazing guests. We are going to be talking about the opioid crisis here in Minnesota. I have Dr. Aaron Burnett with me who is one of the medical directors at Regions EMS and is the medical director for St. Paul Fire. And also, I have Steve Sampson, who is the assistant chief of St. Paul Fire. So, welcome both of you to the podcast, and thanks for being here.
Steve Sampson:
Thank you.
Aaron Burnett:
Thanks.
Kari Haley:
So just to start things off here, wanting to talk a little bit about the opioid crisis in general. So, I think a lot of people probably hear stuff from TV or social media, but what is the reality? Especially here in St. Paul, Minnesota, what are we seeing, and why is this topic important?
Aaron Burnett:
So opioids, they're a class of drugs that have been around for a really long time. Morphine is kind of the classic opioid. And so, we've used them in medicine under a doctor's supervision to treat pain for ages, and they have a very important role to play there. But as with some substances we've seen, people can abuse opioids and get addicted to them. And so, what we've seen over the last couple of years, probably over the last decade really, is a transition in what is most available on the streets for individuals who use drugs. And while we still see cocaine, we still see methamphetamine, there's been a noticeable trend towards opioids. And that likely had some to do with the physician prescribing practices about 15 years ago, and has some to do with the industrial quantities of fentanyl, which can be made in a factory.
But suffice it to say what we've seen is, individuals who are using drugs recreationally on the street have started to use opioids much more commonly. And that's really dangerous, because opioids can stop you from breathing. Every drug sort of affects your body in different ways. And the main side effect that we've known about for opioids for years is that, at high doses it can stop your breathing. That's why when we give them in the hospital, we often have people on oxygen monitoring, we're giving them supplemental oxygen, we're watching their breathing very closely. Obviously that's not happening when somebody's using out on the streets.
Kari Haley:
Yeah. And Chief Sampson, can you maybe talk a little bit too about the trends? So what has changed over the last 10 years on the streets of St. Paul? Have we been seeing more activity with opioid use, more overdoses? And how is that affecting our citizens and the people that are caring for them?
Steve Sampson:
Yeah. I mean it's certainly that timeframe. I think all of us beyond anecdotally are noticing just a dramatic upswing of occurrences. And the other thing we're seeing is like overall, our call volume is off the charts. But it certainly feels like the consistent call volume specific to opioid-related incidences is continuing to increase. Whereas before it might be an isolated unique case, where an individual overdosed from a single kind of source or from a single occurrence. Now we'll have three or four calls that happen. We are able to almost triangulate an epicenter where that's happening. And certainly since COVID and some of the encampment, and the issues that landed at some of the congregate care centers, we're noticing a heightened concentration, like a focal area that oftentimes is hitting some of our most vulnerable communities.
Kari Haley:
Yeah. I think that's one of the big pieces that I really kind of maybe want to talk a little bit about too is, these Opioid addiction can affect everyone and anyone. But there are certain populations that are much more vulnerable, especially to the bad effects. So they end up having a lot more of the decreased access to care, decreased access to treatment, to be able to treat any sort of addiction or substance use disorder that they have. So, how can the coordination between our hospital, and the pre-hospital setting, and the fire department help target some populations that may otherwise not be able to access some care?
Steve Sampson:
How we got to where we are right now, we gave a presentation to the St. Paul City Council back in May of 2024. And one of the things, it was kind of a joint, like how is the city responding to the opioid crisis? And it was the police department that actually put up a map during their presentation. And that map, and I'll show it here, but just for the listeners, the thing that really stood out to me in particular, was the fact that there was not a single corner, a single street, a single ward that wasn't impacted by it. The entire community of St. Paul here where we serve, it is impacted by this. And that's every single one of our fire companies, not just a certain part of town, that's all of them that are responding to this.
And I mean, we had cases where we were responding to the same individual two or three times within a 24-hour period, a single company would go in on the same individual. So for us, our folks were craving an ability to help these folks beyond what we currently had, which was essentially Narcan, and then the ability to get them to a hospital. But again, we'd be seeing those same individuals several hours later going through the same stuff. So not only did our folks, our personnel specifically need additional help, but certainly those individuals that are out there that are really, really struggling with addiction, they need that, they needed something else. And really, that's where it kind of spurred some additional conversations. And that's where Suboxone was introduced for us on the streets.
Kari Haley:
Yeah. Maybe a little bit of a segue just for our listeners, Aaron, talking a little bit about Suboxone and what that is, and why it's effective. And then maybe a little bit how the program then started that is going on right now.
Aaron Burnett:
Yeah. So, the way I think about Suboxone is, so Suboxone binds to the opiate receptor in your brain just like an opiate would. And if you think about it like a light switch, when somebody uses fentanyl, or morphine or an opiate, you can think about the lights getting turned full bright in the rooms, or full bright lights. The receptors are completely activated. Now you can shut those receptors off with a drug called Narcan or Naloxone, and that's something that I think the public is becoming increasingly aware of. In Minnesota you can buy it over the counter. It comes in an auto injector for an intranasal route of administration that people are being trained on. And Narcan will basically displace or kick off all the opiate, all the fentanyl, all the morphine off the receptor immediately. And so, it'll take a very bright room to a completely pitch black room in my analogy.
So, if you think of Suboxone, Suboxone is really a dimmer switch to those lights, and it will always turn the lights to 50%. So that's the beauty of Suboxone is, it will never turn the lights on fully. So you won't get a high, or a euphoria, or altered mental status from the Suboxone. The lights will never be bright, but the lights will never go out either. And going out is really what withdrawal is. And so, Suboxone is designed to keep the lights in your room right at the midpoint, not too bright, not too low. And really the beauty of preventing the lights from going off is that you can prevent people from going through withdrawal. Which is one of the other very unique aspects of opiates. Is the withdrawal syndrome you go through when you stop opiates is very disturbing, very painful, and unlike what we see with other drugs such as cocaine or methamphetamine.
Kari Haley:
Right. And I think that that's really good. Maybe the general public doesn't know necessarily is like, when you have a substance use disorder and your substance that you use is opioid, so an opioid use disorder, you can actually have withdrawal symptoms from stopping the opioid that you're consuming. And those symptoms can be very debilitating, and they can last for a really long time as well. And I think that's maybe some of the uniqueness of Suboxone versus Narcan, which other people know about, like you're kind of saying. So what are we doing with Suboxone? What exactly is happening in the pre-hospital setting? What's the program?
Aaron Burnett:
Well, here in St. Paul we've developed a program where we're really trying to address two groups of patients. The first group is patients that suffer to drug overdose and opiate overdose, and we're given Narcan by bystanders to save their life. And it does, it saves their life. But especially when people get a very large dose of Narcan, it also turns the lights in their room completely off. So they're in full-fledged withdrawal, they're vomiting, they feel terrible, their heart rate's fast, they're agitated, sweating. What we're trying to do, is to address those patients who we see all the time when we're called to a drug overdose, or a person not breathing. And bystanders by the time our medics get there, have already given them the Narcan. So the patient is breathing, and that is the goal, but they're unfortunately also in a lot of withdrawal.
And so, in the past we didn't have the Suboxone that could immediately make them feel better, and now we do. And we're really hoping to take advantage of that lowest of low points that that individual is feeling. Because the Narcan they just received, while it did save their life, it put them in horrible withdrawal. And now we have something that cannot just get them feeling better, but the studies in the medical literature show that if you get people started on Suboxone right after they overdose, the number of patients who remain sober, remain in treatment, and ultimately the number of patients who don't die improves. And so, this is really a life-saving medication that we didn't have outside the hospital walls until now.
Kari Haley:
What's your envisionment for the continuation of this program, and what are your goals for it?
Steve Sampson:
It's twofold. One is just sheer awareness that we have this as a resource. And so, we've been super proactive in who we've been engaging with, to make sure that the word is out there. And so, we've kind of targeted two primary groups. One is like the outreach folks, the folks that are in the encampments specifically every single day that are working out of our shelter space. We want them to have awareness that we are now carrying this. And we think that that kind of front-loading the information with the folks that are directly engaging is going to be super beneficial. For one, because they're already kind of living in this world, and they're already dealing with their clientele. They know who those folks are that are suffering from opioid-related addiction. They know the groups and the encampments specifically that are ravished with these substances.
And furthermore, they have resources, and knowledge and awareness as well. So, some of those engagements directly with the outreach people have been super beneficial. And there hasn't been a single one that Dr. Burnett, that we've been on, where we haven't gotten feedback that's either reaffirmed what we're doing, or else provided additional resources as far as what's available out in the community. So that's been really kind of mutually beneficial there. And then the other group is simply like, who we as an entity within the city of St. Paul, who we engage with. So our librarians, our police department staff, our Ramsey County, the public health department. We are engaging with them so that a) they have awareness that what we are showing up with, that conversations that are taking place between our crews and the patient or their families, whoever it might be.
I want the law enforcement officers, I want the librarians to be front-loaded with that information, so we're not just coming in with lights and sirens, showing up and then engaging directly with them without there being awareness to what we're doing. And all of that's been very, very appreciated. Because just as I mentioned, I mean, our crews are going on these calls every single day. Regions' emergency department is dealing with overdose individuals every single day, but so are the librarians, and so are our law enforcement officers that are showing up on scene and noticing somebody. And all they have right now in theory is that Narcan that they carry on their belt. So some of these additional conversations that we're having is just generating additional awareness to what we're showing up with, or what we can show up with, if in fact additional resources are called for.
Kari Haley:
That's awesome. I think, just for people to have that awareness that there's some dedication to this, and there's a lot of movement behind it. What kind of lessons have you learned going through the process of starting this program, implementing this program, hearing from the outside people that you've been able to have conversations with? What are some of the biggest lessons that you've taken away?
Aaron Burnett:
In speaking with one of our community groups, we were really discussing how we were trying to incentivize people to come to the emergency room after we give the Suboxone, so that we can get them tied in with our clinics. And it was really interesting to hear from several of the community groups, that they wanted to take a different approach. And they really didn't feel that the emergency department was meeting the needs of the patients that we are going to be treating. That many of them have been to the emergency room maybe dozens of times, and it just isn't working.
So the community groups really pushed us to keep thinking outside the box, and to think about, is there an opportunity for us to bring a patient directly to a detox center, as opposed to a general emergency room? Is there a way to potentially even link that patient up directly with a clinic, after they received their Suboxone at the ambulance, but don't come to the hospital? And we don't have the answers to all those yet. But having a group push to say that's what we should be thinking about, I don't think we would've had that unless we listened to them and reached out.
Steve Sampson:
From my perspective, I mean, there's been a systemic swing, it feels like, from my perspective as far as who we are required to take to the hospital, and who now we necessarily wouldn't, but five, 10 years ago we absolutely would've. So this swing, just like our diabetics, we are able to provide that patient with sugar, and get their glucose back up into a normal range for that individual. And we're not mandated to take them to the hospital. And this is kind of the same clientele. These folks oftentimes, like Dr. Burnett mentioned, there's a lot of trauma there. There may be some legal concerns, where they might have a warrant, out and they're not comfortable going into a setting where they know law enforcement's going to be. All of these things have been kind of advocated for on behalf of those individuals by these outreach groups that made us aware that, "Hey, the ED might not be the best location for them."
But one thing that came through on that is like, "Well, we are not going to prevent or stop a lifesaving medication to getting in the hands of those individuals that may need it." And so, that's one of the things that I'm grateful for most about this partnership in our program right now, is the fact that we have the ability to meet them where they are. Whether that's an encampment, whether that's in their mom's basement, wherever it is. If they need the medication, they want to have the conversation, if they're interested in it, we'll show up and have that conversation with them. And if they meet the certain parameters to receive the medication, we'll give it to them. The other thing is that, if they're not ready, we'll just have those conversations, be able to follow up with them potentially in the future. And that's something that we're continuing to build this program.
The last thing we wanted to do is wait on this program, to push it out when it was perfect, and then lose all the time of trying development when the program's good and the medication's great. So, all of those things that helped push this thing rapidly, getting into approved through the DEA, approved to carry, and obviously through the medical direction team, and then ultimately to have it on the rigs in a real short amount of time. It's a solid program that's built on the lessons learned from many agencies and peer review studies across the country, and we're grateful for all that, all of this. We're not unique in servicing a population that suffers from the opioid crisis. We certainly aren't, and we recognize that. And there's a lot of agencies that are out there that are all kind of building up from the same platform. And we've been very, very fortunate be able to glean info from some of our partners across the country.
Kari Haley:
I think that really ties into a lot of the themes that we've done in this podcast over and over and over, is like meeting patients where they're at, building trust within the community. And I think maybe a unique spin that we have here is that, we have firefighters, so firefighters versus the outside ambulance agency that may be private. These are firefighters with their stations within the community. And there's just that different level of trust perhaps, in taking these medications. I know maybe we've had a little bit of this conversation outside the walls of the podcast before. But maybe if you want to elaborate a little bit on how that may be unique, and really trying to build trust within the community to receive lifesaving treatment.
Aaron Burnett:
Yeah. So you know, a fire station isn't just a building, it's part of the community. And that's one of the unique things about the fire services. Their stations are embedded in the neighborhoods they serve. And in St. Paul at least, I mean, I know our fire stations have the doors open in the summer, and the kids are coming to play. And so it's a much less intimidating way to be approached by someone in an official realm than even coming to the hospital. There's a power dynamic sometimes that comes into play in the hospital between patients and the larger health care system, who oftentimes have failed them in the past.
We don't see that with the fire service. We see a level of engagement from community members who I would say traditionally are more apprehensive about interacting with the official services from the city. We see that in a way at the fire stations on a day-to-day basis, that I think is really going to facilitate the community being more comfortable getting this medical advice from a St. Paul firefighter, than it would even from a doctor or a nurse at the hospital.
Kari Haley:
What are the hopes and dreams for the program? And what are some of the things that we can continue thinking about doing? One. And then two, I think, what can other people do? So, what can people who are listening who may or may not have anything to do with health care, how can they help support this type of program? How can they help provide education or expand education on it?
Steve Sampson:
I want to circle back on one aspect that was previously brought up. And that is meeting them where they're at, that whole concept. We are willing to go engage with them. And then as I mentioned, we're not forcing or mandating transport to one specific hospital. If they're a veteran and they need to go to the VA, we'll absolutely transport them to the VA, even if we administer this box and are engaged in those conversations. Same thing if they need to go to a different hospital outside of the immediate core area, we're willing and able to do that. We want them to get the medication, because we know the medication saves lives, and that's the most important aspect. And we're even exploring other alternative locations. And Dr. Burnett kind of hit on this as well. But the ability to take them directly to a clinic for the maintenance side of things, the ability to take them directly to a detox facility, all of those things are kind of tied in what the future of this program may look like.
Right now we have a very focalized group as far as who's carrying the Suboxone. It's kind of our supervisors, our EMS supervisors that are out on the street. So anytime that there is the chance to engage with an individual on an overdose basis, or someone that is in the throes of trying to kick opioids, hasn't used in 12 hours and now they're really sick, we can call in that unit. And they'll bring that medication, they'll bring the resources, and the tide changes a little bit. We're not counting minutes at that point. We're talking about engaging with a human and everything slows down. It's not how fast can we get them to the hospital, because we have more time on these. So all of that kind plays into it.
And again, just a different approach than how we normally operate. And that's how we have to engage with this group, so that we can try and get past this, because it's impacting a lot of them. So, from my perspective, the fact that we have our EMS supervisors carrying this, we've really kind of pared down and focused on our super-user group. They've gone through all the online training, they've gone through the in-person training. They're very, very well versed on this. And furthermore, it is a controlled substance, so we have to monitor that part of it as well. But I think in the future, if we realize or recognize that we're not able to engage directly enough, directly with the folks out on the street, we may want to expand who has access to this medication, and get more on there. So that we're shortening the time for administration, and we're heightening the amount of awareness as far as information exchange with the patients and the crews.
That might be the future, is more global push. I'm grateful for the approach that we took, because it got the medication on the streets. And as you already pointed out, it wasn't just a matter of, I think, approximately 10 or 12 days that we actually administered our first dose. So it is a continued work in progress. Is it perfect? No. I mean, we are still struggling obviously on the maintenance side of things, who we can refer to, bridging some of those gaps, if you will, in services for the full wraparound. But I feel like that is going to be kind of the next phase, if you will, to ensure that our residents in the community itself, that there are resources out there that continue to help support them in the throes of addiction.
Aaron Burnett:
You know, we're trying something new, because everything that's out there is working a little bit, but no one's found what's really working. So, it's going to be interesting to see how this program rolls out. And I think we're going to keep a very open mind to having to adjust and change and respond. I think it'll be very valuable to hear from those community groups. We committed to getting back to them about six to 12 months after the program went live, to sort of hear what they were seeing, or hear what they were hearing, share our experiences as well. I think the key to this program and to new programs like this, is just a willingness to be flexible and nimble, and a willingness to be able to change. Because this is something completely new. We got a great team in place to oversee it. We got good community partners who are helping to guide us, but we're going to learn a lot along the way. And I have no doubt this will look a little bit different a year from now than it does today.
Kari Haley:
Yeah. Well, I think, like you all said, just getting it started was the first step. And it's great that we were able to move so quickly to get the medication out there, get the training out there, so people were able to give Suboxone if needed. And we're doing what we can right now, to try to put at least a little bit of a dent in the opioid crisis that we all see. Thank you for what you're doing. Thank you for being here today on the podcast, and sharing all of this information with our listeners. Do you have just any closing thoughts, comments, on the opioid crisis or the program in general from either of you?
Aaron Burnett:
I mean, this is definitely something that no matter where you live, anyone that's listening to this, your community is being impacted by this too. So I really encourage you to just take a minute and find out what your community is doing to address this. Reach out to your local fire department. Get in touch with your local Department of Public Health, and encourage them that this is important. Because as the Chief said, this affects every corner of St. Paul, every socioeconomic group, every ethnicity, every age. And so, this is happening in everyone's community. And the more we can be aware of it, and encourage our elected officials to prioritize responding to this, the sooner we'll find a solution.
Kari Haley:
Great. Well, thank you again for being here, really appreciate it. With that, thank you again.
Steven Jackson:
"Off the Charts" is a production of HealthPartners and Park Nicollet.
Kari Haley:
It is recorded by Jimmy Bellamy, with Creative by Peggy Arnson, Tina Long, Tim Myers, and Jeff Jondahl.
Steven Jackson:
Production services provided by Matriarch Digital Media.
Kari Haley:
Our theme music is by Ryan Ike.