N.J. hospital works to reduce opioids in the ER

A New Jersey hospital has launched an opioid-alternative program to cut down on the abuse of the drugs that have helped to fuel a deadly crisis.

St. Joseph's Regional Medical Center in Paterson has been using opioid alternative protocols in its emergency room since January. Mark Rosenberg, chairman of emergency medicine at the hospital, said the goal is to try to treat most patients without opioids before considering using them.

"All chronic pain starts with acute pain. We also know that all drug abuse starts with the first dose," Rosenberg said. "If we can stop using opioids before we give the first dose, then people won't become addicted."

In the first two months of the program, 75 percent of the 300 patients that have gone through the Alternatives to Opiates (ALTO) program did not need opioids, Rosenberg said. Doctors are instead are using non-opioid medications — such as acetaminophen or anti-inflammatory drugs — and procedures that block nerve pain.

The program at the hospital, about 20 miles northwest of New York City, comes as public health and law enforcement officials around the country are working to tame the deadly opioid crisis.

Opioids are highly addictive drugs that include both prescription painkillers like codeine and morphine, as well as illegal narcotics, mainly heroin. More than 29,000 people died from opioid misuse nationwide in 2014, the highest figure on record, according to the Centers for Disease Control.

The CDC this month released the first national guidelines for prescribing opioids. They urged doctors to first try non-opioid painkillers, physical therapy and other methods to treat chronic pain.

Emergency rooms find themselves at the front lines of the addiction epidemic, according to Andrew Kolodny, director of Physicians for Responsible Opioid Prescribing. They deal with people in real pain that need to be treated, addicts who lie about symptoms to try to score drugs, and overdose patients.

He points to a New York City program that issued voluntary guidelines on how its public hospitals should prescribe opioids, but said that the emergency department-wide approach at St. Joseph's appears to be unique.

"I think it is unique that they're going to do a variety of measures to avoid" using opioids, Kolodny said of St. Joseph's. "In many cases, we're exposing people to opioids when we don't need to be."

Sergey Motov, the associate research director at Maimonides Medical Center in Brooklyn, has been outspoken on the idea that doctors should be prescribing less opioids. He said doctors should be using a targeted approach to pain management and that more of his colleagues are beginning to embrace the change, including at Maimonides.

"I have no problem with opioids, I have a problem with the way we use them: unintelligently, without understanding them," Motov said. "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."

Rosenberg notes that patients with chronic pain who are already dependent on opioids aren't part of the St. Joseph's program.

"Opioids are a tremendously powerful and appropriate medication to use when all other modalities are exhausted," Rosenberg said. "For my cancer patients it would be wrong not to (prescribe) them opioids to alieve their pain."



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