New Jersey hospital stresses alternatives to opioids

- St. Joseph's Health in Paterson has the busiest emergency department in New Jersey and fourth busiest in the entire nation. Roughly 70,000 patients come through here every year.

Many of them will see Dr. Alexis LaPietra, who is taking a new approach to pain management by making sure highly addictive narcotics stay out of patients' hands. The Emergency Medicine Pain Management Program's medical director said that whenever possible, "we want to try and avoid the opioid."

Dr. LaPietra found that patients were getting hooked on painkillers prescribed by their own doctors. In January 2016, she helped roll out the ALTO, or Alternatives to Opiates, program. The results are nothing short of astounding.

"One year after implementation, we actually found that we had reduced [in-emergency department] dispensing of opioids by 57 percent," Dr. LaPietra said. "Two years after implementation, we decided to look at data regarding what we sent patients home with on prescriptions. And we found that we decreased prescriptions for home 82 percent regarding opioids. We were shocked."

From the nurses to the doctors, the entire emergency department has been trained to use alternatives to pain meds, such as lidocaine, which can be delivered by IV.

"Compared to morphine, it works better for kidney stones," Dr. LaPietra said. "Even nasal sprays to calm some of the irritated nerves that may be contributing to migraines."

The hospital also uses trigger-point injection, a procedure that looks at a "tiny nasty muscle spasm," she said.

The new model ALTO is not only being used in the ER but also in the Department of Obstetrics and Gynecology.

"Before we started this program, we were running at about an 80- to 85-percent opioid use post-Caesarean section while they were in the hospital," Dr. Roger Kierce, the OB/GYN chairman, said. "We've knocked it down 55 percent—amazing reduction."

We met Nicole Hayes less than 24 hours after she delivered twin girls by C-section. She was recovering without any narcotics.

"They've talked to me about the Tylenol and the other options that I have," she said. "And they've been on top of doing that for me."

The ALTO program at St. Joseph's has been so successful that the doctors have helped roll it out at other hospitals across the state and nationwide.

Dr. Mark Rosenberg, St. Joseph's chairman of emergency medicine, recently testified in Washington, D.C., before the energy commerce committee, hoping to make the ALTO program a nationwide mandate. A bill is in the first stages of the legislative process and will be considered by the committee before possibly being sent to the House or Senate for a full vote.

Two other hospitals in New Jersey, Manatee Memorial in Florida, and the Colorado Hospital Association have also adopted the protocols.

Dr. LaPietra continues to travel the country to spread the word about ALTO.

"As we have more patients in recovery from opioid addiction, this is going to become more common—a patient comes in and says, 'I just can't do the opioids,'" Dr. LaPietra said. "So not every condition do we have the alternatives, but when we do, we have to use them and have to know they exist."

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