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New Jersey hospital ER switches from opioids to safer, alternative pain treatment
The emergency department at New Jersey hospital St. Joseph’s Regional Medical Center in Paterson, N.J., is one of the busiest ERs in the nation. And now it’s switching to non-opioid treatments for pain, says a story in The New York Times.
The Times article says that the ER is using opioids “only as a last resort” for the most difficult or chronic pain. Instead, patients with “common types of acute pain — migraines, kidney stones, sciatica, fractures — doctors first try alternative regimens that include non-narcotic infusions and injections, ultrasound guided nerve blocks, laughing gas, even ‘energy healing’ and a wandering harpist.”
St. Joe’s isn’t the only ER in the country reducing its use of opioid painkillers, but it may be the first to go so far into the world of alternatives. Like, what the heck is ‘energy healing’? And we’re kinda wondering about the value of harp music to a sick person – aren’t harps all about angels, the Pearly Gates and dying?
But joking aside, in our experience these are all valuable alternatives to potentially dangerous opioids.
“St. Joe’s is on the leading edge,” said Dr. Lewis S. Nelson, a professor of emergency medicine at New York University School of Medicine. “But that involved a commitment to changing their entire culture.” Dr. Nelson was part of a recent panel that recommended opioid prescribing guidelines for the Centers for Disease Control and Prevention (CDC).
Pain is the reason for 75 percent of visits to an ER. And opioids have been the standard and immediate response to all serious pain for as long as anyone can remember. At St. Joe’s ER, where some 170,000 patients will be seen this year, pain is an overwhelming constant.
“The waiting rooms and corridors are frequently pierced by high-pitched cries and anguished moans,” says the Times. “Such pain can be quickly subdued with opioids — Percocet and Vicodin pills; intravenous morphine and Dilaudid. Most doctors say those drugs can’t be altogether replaced. In extreme emergencies — a broken bone jutting through skin; a bad burn; an acute sickle cell crisis — opioids provide effective, immediate relief.”
The reason St. Joe’s and other medical centers are moving away from opioids whenever possible is because of the constant threat of dependence, addiction and overdose that can occur long after a patient has left the ER.
In most centers, patients go home with a new prescription for opioids. And that’s when trouble can start. There they are at home with a bottle full of OxyContin or Percocet or Vicodin, out of view of the ER and without any supervision. Although ERs almost always info the family physician, many patients don’t have one. But even if they do, there’s seldom any input from the doctor, either.
Though many never become dependent, others do, the Times says. Although ERs write less than 5 percent of opioid prescriptions, they’ve been “identified as a starting point on a patient’s path to opioid and even heroin addiction.”
And as for the alternative treatments’ effectiveness, they’re working pretty well. The Times spoke to one ER patient suffering the excruciating pain of kidney stones. And this patient was a known opioid user and abuser. Instead of intravenous morphine, a standard treatment for such pain, he was given intravenous lidocaine – a non-narcotic painkiller.
“At first I thought, ‘They must have given me opioids!’” the patient said. “But I didn’t have that euphoric feeling or the heaviness in my chest. I was so glad they had an alternative.”
Here at Novus, we applaud efforts such as that being pioneered by St. Joseph’s Regional Medical Center ER, and encourage other medical centers to follow the example. Meanwhile if you or someone you care for needs help because of substance use, don’t hesitate to call us. We’re here to help you find the best solution.
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