St. Joseph’s ER has reduced opioid use by 82 percent

Dr. Mark Rosenberg of St. Joseph’s Regional Medical Center in Paterson told the story of being approached by a man named Michael at an event who wanted to thank him for saving his life when he was in the emergency department for a heroin overdose.

“I said to him, ‘Michael, how did you get started on opioids?’ And he laughed and said, ‘Doc, you were the one who gave me my first prescription. I came in with a shoulder injury and you gave me some opioids.’ This is before we started ALTO,” he said, referring to the hospital’s Alternatives to Opiates program. “I was part of the problem, as most physicians across the country were part of the problem.”

Rosenberg remembers reading articles in the late 80s that said opioids were not addictive and should be given to patients in pain. Today, health care providers write over 250 million prescriptions for painkillers every year.

“We ended up with an entire society that is dependent on opioids, in part by a mistake of the drug companies, physicians, researchers alike,” he said.

According to the Centers for Disease Control and Prevention, of all the people who died of an opioid overdose, 40 percent involved a prescription. That’s more than 46 deaths every day. The CDC also reports emergency room visits for suspected opioid overdoses increased by 30 percent in the U.S.

In 2016, Rosenberg launched the Alternatives to Opiates program, otherwise known as ALTO. Emergency departments like the one at St. Joseph’s in Wayne now have protocols to manage pain without using opioids.

“We use them for certain conditions like kidney stones, back pain, headaches,” said Dr. Marjory Langer.

Rosenberg told the Passaic County Drug Policy Advisory Committee his method is not substituting a lesser pain medication for an opioid; it’s a layering treatment.

“I may be giving a nerve block so you don’t have any pain from the fracture, or I may be giving you a trigger point injection so your muscle spasm actually goes away,” said Rosenberg.

He says the results of the ALTO program have been positive.

“In the first year, we were able to get a 57 percent reduction in opioid use. In the second years, we have a total of an 82 percent reduction of opioid use in the emergency department,” he said.

At the same time, part of the ALTO program aims to get addicted people into recovery.

When a patient comes to the emergency department with an overdose, a call is made to the Eva’s Village hotline. They connect the patient with a peer recovery specialist like Michael Pinckney.

“Some weeks, I’ll go into the hospital, and I’ve seen up to seven people in one night,” said Pinckney. “What we’re trying to do is let them know they deserve better, and as somebody that has gone through the horrors of addiction, it really does help.”