ED Opioid Prescriptions Reduced with Nerve Blocks

Six out of ten overdose deaths in the US involve an opioid drug. Between 2000 and 2015, more than 500,000 people died from drug overdoses. And every day, 91 Americans die from an opioid overdose. 

Facing the Worst Drug Epidemic in US History

This epidemic has been called the worst drug epidemic in the history of the United States. According to the US Centres for Disease Control, the amount of prescription opioids sold in the U.S. nearly quadrupled since 1999, yet there has not been an overall change in the amount of pain that Americans report. Deaths from prescription opioids—drugs like oxycodone, hydrocodone, and methadone—have more than quadrupled since 1999.

We now know that overdoses from prescription opioids are a driving factor in the 15-year increase in opioid overdose deaths. The increase in heroin addiction and overdose deaths followed shortly thereafter, when patients who had become hooked on opioid painkillers were unable to obtain further prescriptions for opiates.

One Medical Centre Moves to Reduce the Opioid Epidemic

At St. Joseph’s Health Care System in Patterson, New Jersey, Dr. Alexis LaPietra, Medical Director of Pain Management experienced a dissonance that is likely familiar to emergency physicians around the country.

“I was in one room, resuscitating a patient who had overdosed on heroin or another opiate, and a few beds down, you’re prescribing opiates for patients in pain,” says Dr. LaPietra, who realised that heroin overdoses often started with a prescription for opioid painkillers in the ER.

While the federal government has been slow to respond to the epidemic, individual hospitals and medical centres have launched their own initiatives to begin addressing the serious health crisis. Realising that prescription opiates are fueling the addiction epidemic, St. Joseph’s made the bold decision to drastically reduce the number of opioid prescriptions originating from their own ED while maintaining outstanding pain control for their patients.

Non-opioid Methods to Combat Pain in the ED and Beyond

St. Joseph’s has the second-busiest Emergency Department in the United States, seeing 175,000 patients in 2016. St. Joseph’s Emergency Department launched the ALTOSM (ALTernatives to Opioids) Programme in January 2016.

The programme uses targeted non-opioid medications, trigger point injections, nitrous oxide, ultrasound-guided nerve blocks, and even meditation, to help ease pain in patients with acute injuries like broken bones, and ongoing issues like migraine headaches.

Dr. LaPietra describes a patient who received a nerve block with ultrasound guidance when the ALTOSM programme first launched, an 89 year-old woman with a hip fracture.

“Hip fracture pain is exquisite,” says Dr. LaPietra, “They are in a lot of discomfort. They cannot move; they cannot breathe well. And within 5-10 minutes of the [ultrasound-guided] nerve block, she had complete pain relief.”

But why use ultrasound for nerve blocks?

“It’s very important to be precise, and the ultrasound equipment helps us be precise,” explains says Judy Padula, Vice President of Patient Care Services and Chief Nursing Officer at St. Joseph’s Healthcare System.

Regional nerve blocks are usually the purvey of anaesthesiologists, but increasingly, emergency physicians are adopting the practise to provide relief to patients suffering from acute pain.

Every Patient Matters

The programme has been embraced by the community that is served by St. Joseph’s.

“We have had people who are in recovery who have come to our Emergency Department [for pain treatment], because they don’t want to have opioids again,” says Dr. Mark Rosenberg, Chairman of Emergency Medicine at St. Joseph’s Population Health Initiative. “It… decreased the cost of care while improving and giving better care to the individual.”

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