NJ ER Reduces Opioid Use By Over Half Using Alternatives

In an effort to help reduce the opioid epidemic, one of the busiest Emergency Departments has taken to alternative methods to help ease patient’s pain, and so far, it is showing promising results without Opioids.

St. Joseph’s Medical Center in Paterson, NJ has witnessed a 58 percent drop in the use of opioids in the Emergency Room in the hospitals first year of the trial. It is well known that New Jersey, and Paterson at the forefront, are hubs for opioid use and overdose death rates. This study could begin a turn around that prevents people from receiving opioid medications, and especially to prevent first-time opioid prescriptions from occurring.

Studies have shown that a large number of people often receive their first taste of opioids in the ER. What is supposed to start as just a temporary pain reliever has to lead many people into the grips of a serious opioid addiction, therein fueling the opioid epidemic? St. Joseph’s wants to try and stop that altogether.

“There is a complete change in philosophy, a complete change in culture in the department,” stated Dr. Mark Rosenberg, the Chair of Emergency Medicine at St. Joseph’s in Paterson. However, not all hospitals are as keen to take on this form of treatment, as painkillers are often what is more encouraged by insurance companies, primarily for their lower cost and ready availability.

Since some hospitals around the country have started using alternatives to opioids in the ER:

• In the first two months of the trail, St. Joseph’s sent home 300 patients for pain, 75 percent of them left without any opioid or prescription for opioid medications.
• One hospital in California has seen a decrease of over 35,000 opioid doses during the same period the year before
• In the same hospital, lidocaine use went up by 451 percent, while the use of methadone dropped by 51 percent, and oxycodone by 43 percent.
• A study was published finding that people who saw a “high-intensity” ER provider for pain had significantly higher rates of opioid dependence than people who saw “low-intensity” opioid prescribers (doctors who administered high volumes vs. low volumes of opioids in the ER)

Does Every Case Really Need Opioids?

A lot of young people who are addicted to opioids and even heroin often confess that they first became addicted after a wisdom tooth extraction or a sprained or broken extremity during their teenage years. Because many medical professionals have been so quick to prescribe opioid medications, millions of Americans are now struggling with opioid and illegal substance addictions.

This tendency to overprescribe opioids in the ER is what lead St. Joseph’s to seek out new alternatives. That being said, they are moving away from immediately prescribing opioids who come into the emergency department with claims of muscle spasms, broken bones, and kidney stones, as these alternative methods seem to be doing just fine without the need of powerful and addictive opioids.

Laughing Gas

When a patient comes into St. Joseph’s with severe pain from a fracture, rather than immediately using opioids in the ER to stop the pain, medical professionals are utilizing nitrous oxide, also known as laughing gas.

When used in combination with ultrasounds and dry needling, laughing gas is the perfect remedy for fast, nonaddictive pain relief. Ultrasound technology is then used to locate the nerves that are surrounding the fracture, which is then injected with lidocaine, a numbing agent to block the pain.  

Dry Needling or Opioids

Muscle tension, sciatic spasms, and general spasms are extremely common reasons for trips to emergency rooms. In the past, opioid prescriptions were prescribed, but in order to reduce opioids in the ER, practitioners at St. Joseph’s have started to become more focused on the holistic method of dry needling.

Dry needling, or trigger point dry needling, is very similar to acupuncture, but they are not one in the same. Needling consists of inserting solid needles into myofascial trigger points, which allows those deep tissue muscles to release and relax. This is then followed by a local anesthetic to reduce the soreness from the needle injection.

According to Dr. Alexis LaPietra, who is the medical director of pain management in the ER at St. Joseph’s, opioids are actually much less effective than dry needling in treating nerve pain. “Because it’s so contained, its hard for that medication to actually get into the spasm.” She also adds that dry needling breaks up the muscle tissue which mechanically stops the spasm and the pain, without any form of medication.

Opioids – The Results

While the results of opioid use in the ER has gone down at St. Joseph’s Medical Center, not all medical centers are following suit at the same scale, and many people looking for a quick fix for their opioid addiction are starting to look elsewhere.

Dr. Rosenberg has mentioned that he has been receiving comments from doctors at other hospitals in the area such as, “Why are all the drug users from your area coming to my emergency department?” to which he replies, “It’s because they’re not going to get opioids at our emergency department unless they’re absolutely needed.”

On a nationwide scale, many health facilities have found it hard to follow suit with St. Joseph’s because many insurance companies are hesitant to pay out extra coverage for these alternative methods to opioids in the ER. Rosenberg reports working closely with pharmacists to even find alternatives to the alternatives that insurance providers will be willing to cover. For example, instead of lidocaine patches, many insurances will cover lidocaine ointments and creams.

Whether or not this change will continue to infiltrate more hospitals and medical centers around the country, it is comforting to know that the change is taking place and that major medical centers are eager to find alternatives to the overuse of opioids in the ER.

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