A New Jersey hospital emergency room has adopted a unique approach to patient care by providing patients with alternatives to opioid painkillers.
The Alternatives to Opiates (ALTO) program is being implemented at St. Joseph’s Regional Medical Center in Paterson, the busiest ER in New Jersey. Instead of relying on opioid painkillers, doctors are prioritizing non-opioid alternatives to treat patients in the program. These alternatives include targeted non-opioid painkillers, ultrasound-guided nerve blocks, trigger point injections and nitrous oxide. The patients in ALTO do not include cancer patients or patients who are already dependent on opioids.
The Associated Press reports that of the 300 people who participated in the first two months of the program, 75% of them did not need opioids. Mark Rosenberg, chairman of emergency medicine at St. Joseph’s, explained that the goal of the program is to see patients through their worst bouts of pain. For example, a patient with a dislocated shoulder might receive a nerve block for several days to numb the area so the shoulder can be put back in place, then move on to non-opioid pain relievers after.
“We have to get over the acute pain episode,” Rosenberg told AP. “The first 24 to 48 hours are the worst. If I can get you over that, you’re going to feel a lot better.”
The program seeks to curb the nationwide “epidemic” of opioid overprescribing and abuse. He recalled his 93-year-old mother being prescribed 100 Percocet from her family doctor to treat chronic wrist pain from a fall.
Other hospitals across the country are adopting similar methods to ALTO, including using prescription monitoring programs, establishing chronic pain policies that limit the use of opioids, and training physicians on using non-opioid alternatives.
Health officials on all levels are stepping up to provide guidance on prescribing opioid painkillers. In New York City, officials issued voluntary guidelines on how opioids should be prescribed at public hospitals, while the Centers for Disease Control and Prevention published the first-ever national guidelines for how to prescribe opioids last month—which urge physicians to seek non-opioid alternatives to pain relief whenever possible.
“I have no problem with opioids, I have a problem with the way we use them: unintelligently, without understanding them,” Sergey Motov, the associate research director of Maimonides Medical Center in Brooklyn, told AP. “We need to talk to patients. The patient needs to be given an option. We never talk to patients routinely … we just blindly give them medication and hope they feel better.”
The CDC reports that a record 29,000 people across the U.S. died from opioid misuse in 2014.