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St. Joseph's ALTO – Alternatives To Opiates Featured

St. Joseph's ALTO – Alternatives To Opiates

Reducing the Risk of Opioid Dependency & Overdose

St. Joseph’s is the first in the U.S. to launch a unique approach to pain management without opioids. 

The United States is in the middle of an epidemic, seeing an increasing number of preventable deaths and emergency department visits due to prescription opioid abuse. Every year, healthcare providers write over 250 million prescriptions for pain killers, enough for every American adult to have a bottle of pills.  And every day, 46 people die from an overdose of prescription pain killers in the U.S.

For the majority of painful conditions opioids should not be the first line treatment. In fact, selected conditions such as headache and acute low back pain can be made worse when opioids are used. Physicians must be aware of the non-opioid modalities and medications available, and work to integrate them into their day-to-day practice.

The Emergency Department at St. Joseph’s University Medical Center is the first in the United States to launch an Alternatives to Opiates Program (ALTO), a highly successful and unique approach to acute pain management without the use of opioids.  Initial results of the ST. JOSEPH’S ALTO program are very promising. Up to 75% of patients have achieved adequate pain relief with alternative therapies and there has been a decrease in opioid use by almost 50% since the inception of the program. 

Clinical Solutions to the Opioid Crisis

To combat the prescription opioid problem, St. Joseph’s Health in Paterson, NJ, has developed an innovative program that gives providers options they can use to effectively alleviate pain without resorting to highly addictive medication.

Launched in January 2016, in the Emergency Department at St. Joseph’s University Medical Center, the Alternatives to Opiates (ALTO) program utilizes protocols that primarily target five common conditions: renal colic, sciatica, headaches, musculoskeletal pain, and extremity fractures.

The architect of the ALTO program is Dr. Mark Rosenberg, Chairman of Emergency Medicine and Population Health at St. Joseph’s Health.  Along with Dr. Alexis M. LaPietra, DO, FACEP, Medical Director of Emergency Department Pain Management at St. Joseph’s, the two clinicians have presented across the country on the impact of their program to turn the tide against opioid addiction and overdose.

Eliminating the Risk of Addiction & Dependency

Because opioid dependency starts with the first dose, the innovative ALTO program uses non-addicting, evidence-based alternatives that have a significant safety profile so clinicians never have to give the first dose - thereby avoiding any risk of addiction.       

Alternative therapies offered through the ST. JOSEPH’S ALTO program including targeted non-opioid medications, trigger point injections, nitrous oxide, and ultrasound guided nerve blocks to tailor patient pain management needs and avoid opioids whenever possible.

Initial results of the ST. JOSEPH’S ALTO program are very promising. Up to 75% of patients have achieved adequate pain relief with alternative therapies and there has been a decrease in opioid use by 50% since the inception of the program.

Successful examples of the ALTO program using alternatives to manage acute pain include kidney stone patients treated with intravenous lidocaine (that not only relieves the kidney stone pain but also allows for easier passage of the stone), back pain patients treated with trigger-point injections, and long-bone fracture patients treated with ultrasound-guided nerve blocks. Receptor management strategies are also utilized to block pain at the receptor site without the need for opioids.  

The ALTO Program uses targeted non-opioid medications, trigger point injections, nitrous oxide, and ultrasound guided nerve blocks to tailor its patients’ pain management needs and avoid opioids whenever possible, for example, in cases of kidney stones, acute low back pain, broken bones, acute headache and migraine pain. 

A model for other hospitals and healthcare providers nationwide, the Emergency Department at St. Joseph’s - the busiest ED in New Jersey with more than 160,000 patient visits in 2016 - is an innovator in Emergency Medicine, having established such programs as the first Geriatric Emergency Department in the US, the first ED-based Palliative Care Program (Life Sustaining Management and Alternatives) in the US, and now, the ALTO program.


Media Links


New York Times
An E.R. Kicks the Habit of Opioids for Pain
http://www.nytimes.com/2016/06/14/health/pain-treatment-er-alternative-opioids.html


YAHOO News
The ER department fighting the US opioid crisis
https://www.yahoo.com/news/er-department-fighting-us-opioid-crisis-062050396.html


Healthcare Business & Technology
Stopping opioid abuse: Hospital uses alternatives to manage pain in ED
http://www.healthcarebusinesstech.com/opioid-abuse-ed/

The Center On Addiction & Substance Abuse
Safer Options: Alternatives To Opioids For Pain Management And Relief 
http://www.centeronaddiction.org/the-buzz-blog/safer-options-alternatives-opioids-pain-management-and-relief

American Osteopathic Association
Outside The Box: DO develops protocols to help patients manage pain without opioids
http://thedo.osteopathic.org/2016/04/do-develops-opioids-last-protocols-at-new-jersey-hospital/

NPR News
No Joke: N.J. Hospital Uses Laughing Gas To Cut Down On Opioid Use
http://www.npr.org/sections/health-shots/2016/04/01/472640008/no-joke-n-j-hospital-uses-laughing-gas-to-cut-down-on-opioid-use 

NJTV News
St. Joseph’s Has First ER with Alternatives to Opioids Program
http://www.njtvonline.org/news/video/st-josephs-has-first-er-with-alternatives-to-opioids-program/

Beckers Hospital Review
New Jersey's largest ER shares findings from Alternatives to Opiates program
http://www.beckershospitalreview.com/quality/new-jersey-s-largest-er-shares-findings-from-alternatives-to-opiates-program.html

Hospitals & Health Networks
The Pain Paradox
http://www.hhnmag.com/articles/7653-How-Three-Hospitals-Are-Managing-Pain-Amid-an-Opioid-Epidemic

CNN: Anderson Cooper 360° Town Hall
Prescription Addiction: Made In The USA
http://cnnpressroom.blogs.cnn.com/2016/05/10/tomorrow-andersoncooper-drsanjaygupta-host-town-hall-re-prescription-addiction/ 

One-On-One with Steve Adubato
ALTO - Alternatives to Opiates Program
https://www.youtube.com/watch?v=n6B7e5cNHII\

News 12 New Jersey
St. Joseph’s University Medical Center program looks to cut opioid prescriptions
http://newjersey.news12.com/news/st-joseph-s-regional-medical-center-program-looks-to-cut-opioid-prescriptions-1.11888798

NJ.com
NJ hospital ER leads nation in tackling pain pill addiction
http://www.nj.com/healthfit/index.ssf/2016/03/nj_hospital_er_leads_nation_in_avoiding_opioid_pai.html

CBS New York
NJ Hospital Cutting Down On Opioids In The Emergency Room
http://newyork.cbslocal.com/2016/03/28/nj-hospital-cutting-down-on-opioids-in-the-emergency-room/

Urgent Matters:
George Washington University – Center for Healthcare Innovation & Policy Research
The ALTO Program
https://smhs.gwu.edu/urgentmatters/sites/urgentmatters/files/4_%20La-Pietra%20Urgent%20Matters%20ALTO%20presenation.pdf


Contact Information

Mark Rosenberg, DO, MBA, FACEP, FAAHPM
Chairman, Emergency Medicine 
Chief Innovation Officer (CINO)
Associate Professor Emergency Medicine
973-754-2240

Alexis M. LaPietra, DO, FACEP
Chair, ACEP Pain Management Section
Medical Director of EM Pain Management
St. Joseph's University Medical Center
Paterson, NJ 07503

Marketing & Public Relations
St. Joseph’s Health
973-754-4500

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