To Reduce Addiction, New Jersey Hospitals Try Non-Narcotic Treatment Protocol

ALTO program may be first in U.S.

In response to an epidemic of opiate addiction, hospitals in northern North Jersey are substituting powerful pain medications with a variety of alternatives to prevent patients from getting hooked, according to a report posted on the website. Patterns of prescribing are changing for surgery; for painful conditions, including kidney stones and fractures, treated in the emergency department; and for flare-ups from back injuries that once guaranteed a Percocet prescription.

At St. Joseph’s Regional Medical Center in Paterson, the new thinking begins in the emergency department (ED).

“If we don’t start opioid use for acute pain management in the emergency department, there is much less chance that a patient will reach for opioids during subsequent treatment, which may lead to addiction,” said Dr. Mark Rosenberg, chairman of emergency medicine at St. Joseph’s.

The hospital’s program, called Alternatives to Opiates (ALTO), appears to be the first in the state, if not the nation, to create a non-narcotic treatment protocol in the ED. Hundreds of ED patients with painful kidney stones, broken bones, back pain, sciatica, and severe headaches have been treated with nerve blocks, anti-inflammatory medications, and other non-narcotics.

The idea is to block receptors at specific points in the body instead of flooding the whole system with pain medication that can make patients nauseated, dizzy, or sleepy—and may not always work, Rosenberg said. Depending on the receptor, physicians use acetaminophen or an anti-inflammatory agent, such as Toradol or ibuprofen, or a combination of drugs. Injections, patches, and intravenous medications are used.

Surgeons throughout northern New Jersey are also prescribing pre-operation “cocktails” with intravenous Tylenol and other medications and are following up with nerve blocks to ease the severe pain of hip and knee replacement procedures instead of relying on opiates.

Besides leading to potential addiction, opioid pain remedies can slow recovery. The pain-relief alternatives are helping patients spend less time in hospitals and rehabilitation facilities, resulting in significant cost savings, according to the article.

The recommendations don’t affect cancer patients, and all physicians—orthopedic surgeons, emergency physicians, and pain management specialists—stress that if pain can’t be relieved with the alternatives, there is a still a place for opioids or morphine in the physician’s tool kit.

In 2014, a record 27,647 Americans were killed by overdoses of heroin and prescription painkillers, according to statistics from the Centers for Disease Control and Prevention. In a first, the agency issued guidelines earlier this month for dispensing narcotics.

Source:; March 27, 2016.