ARI SHAPIRO, HOST:
Fifty-eight percent - that's how much one of America's busiest emergency rooms says it has cut back on the use of opioid painkillers. That drop took place in the first year of an unusual program designed to help stem the opioid epidemic. As part of our Take a Number series, NPR's Hansi Lo Wang went to that ER to find out how they did it.
HANSI LO WANG, BYLINE: One of the places many people are first prescribed opioids is in emergency rooms like this one at St. Joseph's University Medical Center in Paterson, N.J. This is where you come when you just can't stand the pain from kidney stones, broken bones or a muscle spasm, which is what brought Jonathan Milton hobbling into the ER.
JONATHAN MILTON: Oh, my gosh.
WANG: How are you feeling today?
MILTON: In pain.
WANG: A couple nights ago, he was at home lying on the floor watching TV and 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...
MILTON: Like somebody just came in that room, just kicked me and kept moving. At work, I'm walking and I drive the forklift. And I was getting off the forklift, I fell.
WANG: Because it hurt so much.
MILTON: It was hurting so much.
WANG: Milton has come into this ER in pain before, about seven years ago with a shoulder sprain. Dr. Alexis LaPietra looks up his medical records.
ALEXIS LAPIETRA: I did see from your visit you were here for that shoulder sprain May, 2011 and you did get opioids. You got Percocet.
WANG: And back then, LaPietra says, in this emergency room, Percocet and other opioids were part of the first line of offense against pain. But two years ago, she helped lead a program to start using alternatives to opioids, which to be clear, aren't banned in this ER. But LaPietra says sometimes the best way to reduce the pain from a muscle spasm, for example, is with a dry needle or a trigger point injection and not a pill.
LAPIETRA: Because it's so contained, it's hard for that medication to actually get into the spasm. But the needle can get in...
WANG: And break up the muscle tissue and mechanically stop the spasm and the pain. No medication needed. Doctors here are also 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...
(SOUNDBITE OF HARP)
WANG: ...A harpist to roam the halls to soothe patients who are often sent home with instructions to use Tylenol, Motrin or a warm compress rather than opioids.
LAPIETRA: We have to go back to times when things were a little more simple and those easy, at-home techniques, good patient education, really they help a lot with some of that pain that patients have to deal with when they go home.
WANG: But what may sound like common sense, now that we've seen how addictive opioids can be, requires a major culture shift among ER doctors who prescribed these pills for years, like Ninad Shroff.
That must have be very odd when you first started not using...
NINAD SHROFF: Yeah, it took a little bit of getting used to. I mean, I've been doing this for about 20 years. So for me, it was a big change.
WANG: But now two years into this alternatives to opioids program...
SHROFF: Now there are shifts that I get through without ever using an opioid, which to me is unbelievable. But it's amazing.
WANG: And Mark Rosenberg, who is a chairman of emergency medicine at St. Joseph's, says doctors at other hospitals nearby are noticing too. He says they ask him...
MARK ROSENBERG: Why are all the drug users from your area coming to my emergency department? And it's because they're not going to get opioids at our emergency department unless they're absolutely needed.
WANG: Rosenberg says one challenge doctors here have had to work through is the cost of using alternatives to opioids. A few times, they've had to work with the hospital's pharmacists to find more affordable alternatives to the alternatives.
ROSENBERG: 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.
WANG: Other emergency departments have been trying out alternatives to opioids at a smaller scale. But the model that St. Joseph's has developed is now being copied in other hospitals in Colorado and in another New Jersey ER, AtlantiCare Regional Medical Center in Atlantic City where Dr. Thomas Brabson is the chair of emergency services.
THOMAS BRABSON: A lot of people now are very sensitive to the opioid, you know, epidemic. And there's more people asking, you know, what are you giving me for pain and I don't want an opioid.
WANG: People are asking specifically?
WANG: It's a change in expectations you can also see among patients like Jonathan Milton back at St. Joseph's ER. For a shoulder sprain back in 2011, doctors gave him a dose of Percocet in the E.R. and more pills to take home. But on this morning for his muscle spasm from sleeping on the floor, Dr. Jessica Lim put a patch of lidocaine on his left side and told him to take Motrin and Tylenol and to stretch at home.
JESSICA LIM: We were considering giving you a muscle relaxer, and I know you don't like that feeling. So we're not going to give it to you, OK? So this is even more on you to do the work yourself at home. And I know a lot of patients don't like hearing that.
WANG: But Milton's OK with that because he's leaving the ER with no opioids. Hansi Lo Wang, NPR News, Patterson, N.J.
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