NPR's "Take A Number" series is exploring problems around the world — and solutions — through the lens of a single number.
One of the places many people are first prescribed opioids is a hospital emergency room. But in one of the busiest ERs in the U.S., doctors are relying less than they used to on oxycodone, Percocet, Vicodin and other opioids to ease patients' pain.
In an unusual program designed to help stem the opioid epidemic, the emergency department at St. Joseph's University Medical Center in Paterson, N.J., has been exploring alternative painkillers and methods. That strategy has led to a 58 percent drop in the ER's opioid prescriptions in the program's first year, according to numbers provided by St. Joseph's Healthcare System's chair of emergency medicine, Dr. Mark Rosenberg.
"There is a complete change in philosophy, a complete change in culture in the department," says Rosenberg, who launched the Alternatives to Opiates program in 2016 with Dr. Alexis LaPietra, the medical director of pain management in the emergency department.
Last year, the program was highlighted during a visit to the hospital by the chair of President Trump's commission to study the national opioid crisis, former New Jersey Gov. Chris Christie.
Patients are experiencing the shift in care for painful symptoms related to various diagnoses, including kidney stones, broken bones and muscle spasms. It was a muscle spasm and a deep bruise from a subsequent fall that brought Jonathan Milton, a 43-year-old forklift driver from Jersey City, N.J., hobbling into St. Joseph's ER one morning in January. A couple nights earlier, Milton was at home, lying on the floor and watching TV. He accidentally fell asleep on his left side. When he woke up the next morning, he could barely get up. From his left hip down to his leg, he says, the spasm left him feeling "like somebody just came into that room, just kicked me and kept moving." Later at work, when he tried to get up into the forklift, he fell. "I was so much in pain — tears were coming out my eyes," he said as he waited in a hospital chair for more instructions from his doctors. Milton has come into this ER in pain before. "I did see from your visit you were here for that shoulder sprain," said LaPietra, after checking the hospital's records about Milton's 2011 visit. "You did get opioids. You got Percocet." Back then, opioid painkillers were part of the emergency department's first line of offense against pain. Today, opioids are not banned, but LaPietra says sometimes the best way to reduce the pain from a muscle spasm, for example, is dry needling of a trigger point, not a pill. "Because it's so contained, it's hard for that medication to actually get into the spasm," she explains, adding that the dry needle can break up the muscle tissue and mechanically stop the spasm and the pain — with no medication needed. The dry needling is followed with a small injection of a local anesthetic for the soreness caused by the needle. The ER team at St. Joseph's employs a number of other pain-relieving strategies, too: using patches of lidocaine (a non-opioid painkiller); ultrasound to find nerves so they can inject numbing agents; laughing gas for patients to breathe in through a mask, and even a harpist to roam the halls to soothe patients, who are then often sent home with instructions to use ibuprofen, acetaminophen or a warm compress rather than opioids.