New Tools to Fight Opioid Abuse and Addiction, Starting in Emergency Room

A unique pilot program at St. Joseph’s Regional Medical Center relies on less-addictive painkillers in the ER, gives patients an alternative

St. Joseph’s Regional Medical Center in Paterson
President Barack Obama has outlined a number of new initiatives to combat America’s growing crisis of opioid and heroin addiction, announcing more than $1 billion in federal programs and direct state assistance in recent weeks as part of an increasingly comprehensive approach to expanding treatment and preventing abuse.

In New Jersey, where high rates of addiction have claimed an estimated 5,000 lives in the past decade, a number of medical providers may be ahead of the curve when it comes to curbing the disease. One example is a unique pilot program at St. Joseph’s Regional Medical Center in Paterson — which organizers said is the first if its kind nationwide – that encourages the use of less-addictive painkillers for most emergency room patients. Other physicians and hospitals, including Holy Name Medical Center in Teaneck, are also taking steps to reduce opiate use for pain management.

Since its start in January, the St. Joseph’s pilot — ALTO, or Alternatives to Opiates — has allowed more than 300 patients who would normally have received narcotics to instead get nonaddictive pain medication, direct injections of nerve-numbing drugs, and other opiate-free alternatives for conditions ranging from back pain to broken bones. The program also sparked a private-policy roundtable earlier this week with U.S. Senators Robert Menendez and Cory Booker (both Democrats), Rep. Bill Pascrell Jr. (D-Paterson), acting state Health Commissioner Cathleen D. Bennett, hospital officials, physician representatives’ and other healthcare experts.

“It’s a really smart way to approach treatment,” said Sen. Joseph Vitale (D-Middlesex), chair of the Senate Health Committee, a leader in the state’s efforts to reduce addiction who was invited but unable to join Monday’s roundtable. Over-prescription, “no doubt it’s contributed to the epidemic,” he said.

Vitale said an even greater concern is extra pain meds that are often left in medicine cabinets, since statistics show these forgotten prescriptions are the first step for nearly 70 percent of addicts. He continues to work with fellow lawmakers and state officials to improve a program started last summer, Project Medicine Drop, which provides a list of sites for safe disposal of unwanted pharmaceuticals of any kind.

More drugs, more death

This state trend also dovetails with recent federal recommendations designed to cut down on the number of patients who end up addicted and reduce the availability of pills that can be diverted for illegal use. On Tuesday, Obama joined a national summit on prescription drug and heroin abuse in Atlanta and participated in a discussion with former addicts and treatment providers.

Data suggests that physicians wrote more than 200 million opioid prescriptions nationwide in 2014; some 19,000 people overdosed that year, the highest number ever recorded, with almost 10,000 additional deaths connected in some way to drug use. Statistics also show that rising death rates mirror the increases in prescriptions written for these drugs.

“These are tragic and preventable deaths,” said CDC director Dr. Tom Frieden in a press conference with reporters last week. As a national health concern, “It’s one of the few problems in the U.S. that is getting worse.”

Frieden said the Centers for Disease Control and Prevention guidelines are not designed to prevent pain patients from obtaining the relief they rightfully need. But, he added, “We recognize that starting an opioid is a momentous decision that could derail someone’s life.”

Earlier this month the CDC released the first guidelines for prescribing opioids, which call on doctors to carefully review the risks, dosing, and long-term implications before recommending these drugs and encourage them to first try non-addictive pills like ibuprofen or aspirin, physical therapy, or other methods for treating pain. The guidelines do not apply to certain conditions like cancer treatment and palliative care, for which opioids may be the most appropriate course.

[related]The Federal Drug Administration has also pushed physicians to take more responsibility for curbing addiction and is encouraging drug makers to do more to educate doctors on the dangers associated with opioid prescriptions. The FDA is also encouraging pharmaceutical companies to develop less-addictive alternatives and to include a “black box” warning label on opioid medications.

Obama’s visit to the addiction summit in Atlanta included a call to double the number of patients — now limited to 100 — each physician can treat with buprenorphine, a highly successful replacement therapy for opioid addicts. While the programs he has outlined recently are largely focused on treating existing addiction, his visit Tuesday was reinforced by a promise from some 60 medical schools that their students will be required to learn the new CDC opiate guidelines in order to graduate.

In New Jersey, Gov. Chris Christie has invested significant time and resources in programs to expand access to addiction services and treatment. In the past year alone, the state launched a hotline to connect callers with addition programs, hired former addicts to help current drug users in crisis, and helped equip emergency responders and other experts with Narcan, an injectable drug that can reverse an opioid overdose in seconds.

Curbing the pharma flow

The Garden State has also pursued programs to reduce the volume of opioids prescribed. The staff at the attorney general’s office is now working with local law enforcement and state licensing boards to reduce unlawful opioid distribution. What’s more, and health officials are beefing up the five-year-old prescription monitoring program, a database that connects all prescribing physicians and pharmacies in an effort to identify patterns of abuse, addiction, and diversion. (Last week, Obama wrote to all 50 state governors encouraging them to create truly effective prescription databases.)

“Drug addiction is a complex issue that requires a comprehensive and coordinated approach. The face of addiction knows no bounds,” acting health commissioner Bennett said. She praised the St. Joseph’s program as part of web of public and private efforts to combat the disease and credited the Governor’s Facing Addiction Task Force for “bring(ing) together cross-cutting sectors to address the challenges of addiction.”

Mishael Azam, COO and senior manager for legislative affairs for the Medical Society of New Jersey, said her organization has been active in addressing addiction issues and will continue to host free education programs to help physicians it represents “learn about new tools and best practices.” MSNJ supports plans to improve the state’s prescription monitoring program and a new law designed to better educate patients about safe storage and disposal of addictive medicines, she added.

Azam, who also participated in the St. Joseph’s roundtable, echoed physicians at the event who said they had an important role to play in preventing abuse. “But we also need to ensure access to medications to patients who truly need them for their quality of life,” she said.

St. Joseph’s, which officials said has the state’s busiest ER with more than 180,000 patients a year, may be the first to implement a formal protocol, but other facilities and even private physicians who treat pain patients are pursuing similar efforts, reports suggest. Holy Name CEO Mike Maron said his hospital has had luck reducing initial opioid doses for both emergency and inpatient treatments, instead employing options like intravenous acetaminophen. When these alternatives are in place, Maron said surgeons are less likely to prescribe addictive options.

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