NJ Hospitals Roll Out Phase 1 of Effort to Reduce Prescribing Opioids in ER

Lilo H. Stainton | November 5, 2019 | Health Care
Multiyear initiative seeks to cut opioid prescriptions to under 12%, collect statewide data to reveal trends and trouble spots

Nearly a dozen New Jersey hospitals make up the first wave of facilities to participate in a statewide initiative to reduce emergency room opioid prescriptions by more than one-quarter in the coming year. The program — under discussion for at least 18 months — seeks to prevent and reduce drug addiction, while improving patient care.

Officials from the state departments of health and human services joined hospital leaders Monday to formally launch the Opioid Reductions Option program, or ORO. The state will also invest $1 million to help participating hospitals develop and implement protocols to ensure clinicians consider alternatives to these highly addictive pain medicines whenever possible.

National studies have shown some 17% of emergency room patients are discharged with a prescription for highly addictive opiates, and prescription medicines are responsible for the majority of new opioid addictions. Other research has suggested that non-opioid drugs, including over-the-counter options like ibuprofen acetaminophen, can be equally effective for treating some pain.

The funding will also support work by the New Jersey Hospital Association and St. Joseph’s Health system — whose successful Alternatives to Opioids, or ALTO, program, has become a national model — to lead the multiyear project. St. Joseph’s Medical Center in Paterson cut opioid prescriptions by 80% with ALTO, according to those involved, opting instead for nerve-blocking injections and non-addictive medication to treat pain.

Cathy Bennett, president and CEO of the New Jersey Hospital Association

“We found out through St. Joe’s experience with ALTO that you could do something other than prescribing opioids. That was sort of the genesis,” said NJHA president and CEO Cathy Bennett, who previously served as state health commissioner. “The expertise and the lessons they have learned (in their national work) are going to be invaluable to us statewide,” she added.

While the hospitals selected by the state can develop their own individual approaches, each program must be rooted in evidence-based models and proven practices for addressing specific medical conditions, hospital officials said.  The shared goal is to reduce the patients discharged from New Jersey emergency rooms with opioid prescriptions to 12% or less.

The ORO program also requires standardized data collection and reporting that will enable the NJHA to analyze the results and identify statewide patterns, something Bennett said will put the Garden State in a unique position. “You can start to see what’s working and what’s not,” she said. “When you’re all agreed on what you need to measure and how you’re measuring it, you can really make change happen.”

And while the first cohort is limited to 11 hospitals — stretching from Atlantic to Sussex counties — Bennett said additional facilities would be added in the coming year. Plus, she said other facilities are already exploring how they can also make changes; for example University Hospital, in Newark, announced an initiative of its own earlier this fall.

“We have achieved much more than just (engaging 11) hospitals” in the program, agreed Dr. Mark Rosenberg, chair of the emergency medicine department at St. Joseph’s Health and one of ALTO’s creators. “I think we’ve achieved bringing awareness to every hospital in the state.”

Garden State makes inroads against opioids

New Jersey has already made strides to reduce legal opioid use through various laws, with a 21% decline in the total number of prescriptions issued between 2012 and 2018 by all clinicians, according to the state Department of Health. But the state recorded more than 2,000 fatal overdoses this year, through September; DOH acting commissioner Judith Persichilli said there are eight drug-related deaths daily, on average.

“Hospitals are critical partners in addressing substance-use disorder,” Persichilli said. “We know that any prescription written for opioids could serve as a gateway to addiction.”

The issue is certainly not limited to the Garden State; U.S. Sens. Robert Menendez and Cory Booker (both D-NJ) pushed to have a national pilot program based on ALTO included in an anti-drug measure President Donald Trump signed last fall. “Every single community and every single state are looking for solutions,” Rosenberg said.

A look at ORO

New Jersey’s ORO program, which involves both the state health and human services departments, is also designed to ensure patients get the pain relief they need, which in some cases will still involve opioids. In addition, it intends to help those with substance-use disorders address other health concerns and reduce the risks associated with their continued drug use (distributing an overdose antidote, for example.)

Dr. Shereef Elnahal
Dr. Shereef Elnahal, former state health commissioner, now heads up Newark’s University Hospital.

Former state health commissioner Dr. Shereef Elnahal, who now heads University Hospital, endorsed the idea of expanding an ALTO-like program to emergency rooms statewide during a June 2018 roundtable discussion on preventing opioid abuse, sponsored by NJ Spotlight. The event also featured Rosenberg, who discussed his work with ALTO.

Gov. Phil Murphy then included the proposal on a list of diverse efforts to address addiction that he outlined at a public event in Camden, last January; at the end of April the DHS issued a formal request for proposals from hospitals interested in participating in the initial round. The RFP indicated the state would invest $1.79 million in the program, over several years, to fund training, technical support and other assistance in as many as 35 hospitals.

State officials said federal funds are going to be used to supplement the program, but the next steps are still under discussion. They were unable to say exactly how the $1 million will be distributed among the selected sites, although the RFP suggests that St. Joseph’s will collect $100,000 for its role. It was also unclear why the program was not announced until this week, while the proposal calls for the funding to be awarded in early August.

The 11 hospitals selected are:

  • Community Medical Center – Toms River
  • Monmouth Medical Center Southern Campus – Lakewood
  • Monmouth Medical Center – Long Branch
  • Robert Wood Johnson University Hospital – Somerset
  • Robert Wood Johnson University Hospital – Hamilton
  • Robert Wood Johnson University Hospital – Rahway
  • Saint Barnabas Medical Center – Livingston
  • AtlantiCare Regional Medical Center – Atlantic City
  • Holy Name Medical Center, Inc. – Teaneck
  • Capital Health System, Inc. – Hopewell
  • Newton Medical Center (Sussex County)