Nationwide Expansion of NJ Program to Reduce Opioid Use

Strategy makes opioids the drug of last resort in emergency rooms, cutting their use in state’s busiest ER by more than 80 percent

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Another New Jersey program to address opioid addiction has become a national model, as federal lawmakers seek to replicate an approach developed by St. Joseph’s Medical Center that has greatly reduced use of these addictive drugs in the hospital’s emergency room.

U.S. Senators Robert Menendez and Cory Booker and U.S. Rep. Bill Pascrell (all D-NJ), who represents the area, returned to the Paterson hospital Monday, just over two years after they first announced the opioid-reduction program with leaders at St. Joseph’s. Since its launch in January 2016, the initiative — ALTO, or Alternatives to Opioids — has cut opioid use in the hospital’s emergency department, the state’s busiest, by more than 80 percent.

The three leaders are among a bipartisan, bicameral group that last month introduced federal legislation to create a three-year nationwide pilot project based on the St. Joseph’s program. Elements of this proposal have also been included in an opioid-response bill introduced by leaders in the U.S. Senate’s health committee, Booker noted; this legislation is scheduled for a Congressional hearing Thursday in Washington, D.C.

Options other than opioids

ALTO requires physicians and other providers to first consider nonopioid options — like over-the-counter pain medications, nerve-blocking injections, and other less-addictive methods — for emergency patients seeking relief from the pain associated with broken limbs, trauma, or other urgent conditions. When opioids are necessary, ALTO calls for the lowest dose possible, for the shortest amount of time — guidelines like those outlined by federal officials in 2015.

“The work being done here at St. Joseph’s Medical Center is innovative, it is inspiring, and it is shining light against the darkness,” Booker said, calling the opioid epidemic “staggering and epic in its evil.” He praised the hospital’s “visionary, innovative leadership” who are “now pioneers in this national effort.”

Menendez — who co-sponsored a 2016 law to expand prescription monitoring, safe-disposal options, and access to overdose-reversal agents and set national treatment standards — agreed St. Joe’s ALTO program “is at the forefront of innovative thinking and new approaches to treating pain (and) to fighting opioid addiction.”

Nationwide, some 200 million opioid prescriptions are written annually, including nearly 4.9 million during 2017 in New Jersey, according to state data, and close to 1.4 million so far this year. Addicts and dealers often target emergency rooms, which by definition provide short-term care, and many of those who become hooked on prescription drugs eventually turn to street drugs, which are cheaper. Four out of five recent heroin addicts started with prescription pills, studies have shown.

Fighting a growing trend

The federal prescription guidelines, developed by the Centers for Disease Control and Prevention, and state efforts — like former Republican Gov. Chris Christie’s landmark law to limit most initial pain patients to five-days worth of opiates — have sought to reduce this trend.

New Jersey has also led the charge to expand access to highly regarded treatment models and insure long-term insurance coverage for this care. Earlier this month, Democratic Gov. Phil Murphy pledged to invest more in data-driven efforts to prevent and address the healthcare crisis.

But the addiction epidemic is still growing, and overdose deaths continue to rise, in part because of the emergence of powerful synthetic opioids, like fentanyl, which is sometimes mixed with heroin to increase its strength. More than 2,000 people died from drug overdoses in New Jersey in 2016, the last year for which the state has good data, and some 900 have been killed so far in 2018.

Experts have recently embraced the ALTO program — elements of which are under way at other Garden State hospitals — for its potential to help reduce this trend. The effort has become the subject of several recent journal articles, Booker said, and hospitals in Colorado have implemented similar protocols, cutting opioid use by more than one-third in six months. U.S. Sens. Michael Bennet (D-CO) and Cory Gardner (R-CO) are sponsors of the bill.

The legislation, the Alternatives to Opioids (ALTO) in the Emergency Department Act, would create a three-year demonstration project to test these models on a wider basis. The bill would provide block grants to hospitals to develop the programs and would require the federal Secretary of Health and Human Services to report to Congress on the results and offer recommendations for an even larger program.

Following NJ’s lead

“We want to see every hospital and provider across New Jersey and across this nation follow St. Joe’s lead, and our bill provides the necessary federal resources to help make it possible,” Menendez said.

Pascrell, who grew up in Paterson, said the ALTO program has shown “dramatic results” in the region and — with their legislation — can also serve as a national model, “providing emergency rooms across the country with a blueprint for preventing countless overdoses from happening in the first place.”

The lawmakers were joined Monday by hospital officials, including Dr. Mark Rosenberg, chair of emergency medicine at St. Joseph’s, who helped develop ALTO and is scheduled to testify in support of the federal legislation Thursday.

“St. Joseph’s is proud to lead the way in providing a tangible solution to address the opioid epidemic here in New Jersey — and now across the country with this proposed legislation,” said Kevin Slavin, president and CEO of St. Joseph’s Health, which operates the Paterson hospital.