ED providers at St. Joseph's Health in New Jersey are prescribing significantly fewer opioids than they did a year ago due to an internal culture shift and a new program that emphasizes opioid alternatives such as dry needling and lidocaine ointment, Hansi Lo Wang reports for NPR's "Shots.".
About the new program
St. Joseph's University Medical Center in Paterson launched the program, called Alternatives to Opiates, in its ED in 2016. Through the program, the center has revamped its approach to treating pain symptoms that result from several conditions, including broken bones, kidney stones, and muscle spasms, Lo Wang reports.
Instead of using opioids as the first choice for managing pain, ED staff often sends patients home with instructions to use acetaminophen, ibuprofen, or a warm compress. For other patients, the hospital prescribes dry needling or uses an ultrasound to identify and sensitive nerves, which are then injected with a numbing agent.
Alexis LaPietra, the medical director of pain management at the ED, explained that dry needling can be a better form of pain management than opioids for muscle spasms. "Because it's so contained, it's hard for that medication to actually get into the spasm," she said, adding that dry needles can break up muscle tissue and stop the pain.
Mark Rosenberg, chair of emergency medicine at St. Joseph's Health, said the ED lowered opioid prescriptions by 58% within the program's first year.
'A complete change in culture'
The key to program's success was shifting ED providers' approach to pain management, Rosenberg said. "There is a complete change in philosophy, a complete change in culture in the department," he said.
Ninad Shroff, an attending physician at St. Joseph's ED, said that the program has taken "a little bit of getting used to." But now, Shroff said he can get through a shift without prescribing any opioids, something he said he still finds "unbelievable."
The change also required providers to work more closely with pharmacists to find opioid alternatives that are covered by patients' insurance. "The insurance companies don't embrace all the alternative treatments and instead would rather frequently have us prescribe opioids because they tend to be inexpensive and readily available," Rosenberg said.
The success of St. Joseph's program has caused other hospitals to take notice. Some, such as UCHealth in Colorado, have adopted similar programs.
One unexpected side effect of the program is that providers at other nearby EDs have reported an uptick in drug users from St. Joseph's service area, according to Rosenberg. He explained, "It's because they're not going to get opioids at our emergency department unless they're absolutely needed" (Lo Wang, NPR, "Shots," 2/20).
Learn more: How to combat the opioid epidemic
Opioid misuse and abuse is one of the most pressing public health issues in the U.S., and hospitals and health systems are on the front lines. Currently, most health systems focus their opioid management efforts on select medical specialties.
This report outlines three imperatives to guide hospitals and health systems in their efforts to reduce the impact of inappropriate opioid prescribing and misuse.