St. Joseph’s Healthcare System
Based in Paterson, New Jersey, St. Joseph’s healthcare system has a regional medical center that treats more than 1.5 million patients annually—including 163,000 ED visits. The system launched its Alternatives to Opioids (ALTO) program in January 2016, after recognizing an influx of patients in the emergency department complaining of pain and receiving opioids.
“Our goal is to provide medication to relieve pain so that patients can become functional, not necessarily pain free,” says Mark Rosenberg, DO, chairman of emergency medicine and medical director for population health. “We know opioids can effectively manage cancer, but we need to use these pain medications with respect and not only look at their safety, but also at the possibility of addiction.”
ALTO focuses on five key diagnoses that present regularly to the ED: kidney stones, which cause more than 70% of visits for pain; sciatica; migraines and headaches; musculoskeletal pain (back and shoulder pain); and extremity fractures.
The program features:
Alternative therapies emphasizing trigger point injections, such as lidocaine-type medications; nitrous oxide; and ultrasound-guided, nerve blocks.
Therapies specifically chosen because of their effect on pain receptor sites for different kinds of pain.
Efforts to prevent acute pain from becoming chronic, while using opioid alternatives whenever possible.
Programs aimed at eliminating unnecessary use of opioids by incorporating psychosocial support and education for patients.
Rosenberg says that if patients entering the ED are already on opioids, they can continue use if proven effective, but no new prescriptions are allowed for those not yet on opioids.
Rosenberg says there was a 58% total reduction in use of opioids in the ED, along with higher satisfaction and an improvement in patient pain scores, in the first year of the program.
The ALTO program tenets are now embraced throughout the healthcare system, and St. Joseph’s is disseminating the program throughout the United States.