The next time you go to the emergency room with back pain, you might be offered a patch instead of narcotics.
As the opioid epidemic continues to rock Manatee County, Manatee Memorial Hospital and Lakewood Ranch Medical Center are taking action on how they might influence the flow of prescription opioids into the community.
A relatively new method called ALTO, or Alternatives to Opioids, aims to cut down on the prescription of opioids by seeking other routes of pain management. The two hospitals, both managed by Universal Health Services Inc., will be the first healthcare providers in Florida to implement it.
Dr. Alexis LaPietra, the medical director of the Emergency Medicine Pain Management Program at St. Joseph’s Regional Medical Center in Paterson, N.J., paid a visit Wednesday to Manatee Memorial Hospital to help kick off the program. LaPietra developed the method with the hospital’s chairman of emergency medicine, Dr. Mark Rosenberg.
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“Opioid overdose is now the No. 1 killer of Americans under the age of 50,” LaPietra said.
The method is a three-pronged approach: prevention, treatment and harm reduction. Prevention directly relates to how opioids may get into the hands of emergency room patients with acute pain.
“Often-times, we go straight to the narcotics because we want to address their pain quickly,” said Dr. Teresa Rawe, medical director of Manatee Memorial’s emergency department. “You know you’re going to get faster results with that, but faster isn’t necessarily the best result that you need.”
For back pain, for example, a Lidocaine patch or a combination of Motrin and Tylenol could be used instead of the typical narcotic, Rawe said.
Treatment, of course, is about partnering with local addiction services to bring that outreach to the addicted patient in the emergency room. Harm reduction, like a needle exchange program, allows addicts to “survive long enough to get treatment,” LaPietra said.
“We embrace people who come to our healthcare system who are presenting with disease conditions,” she said. “Yet addiction, we don’t embrace. We have to realize these people are suffering, and we need to extend treatment to them.”
In the two years the New Jersey hospital has been using these tactics, they saw a 57 percent reduction in how many opioids they prescribed.
Forty percent of opioid overdose deaths nationwide in 2016 involved prescription opioids, said Stephanie Brown, pharmacy clinical coordinator at Manatee Memorial, to a crowd of about 40 community members and leaders. Eighty percent of heroin users started their addiction with prescriptions, she added.
Manatee Memorial saw 1,096 drug overdoses in 2015 grow to 1,396 overdoses in 2016. Through October 2017, that figure was 1,093.
“We believe this is the right thing as we move forward in developing a program in our emergency department and in our hospital on how to address the opioid issue in our community,” Manatee Memorial CEO Kevin DiLallo said.
Opioids won’t go away from the emergency room treatment spectrum — that would be “barbaric,” LaPietra said. But her method gives healthcare providers an opportunity to educate their patients and think outside the box for pain management.
When the hospital’s new emergency center is completed, Rawe said they will start using nitrous oxide, also known as laughing gas, to treat some pain patients. Other hospitals have turned to alternatives such as acupuncture and aromatherapy. With this, they want to be more “opioid-aware.”
In attendance was Manatee County Commissioner Betsy Benac, who recently had rotator cuff surgery. Her healthcare provider never told her how addictive opioids could be, and on her seven-day checkup they told her she needed more narcotics, she said.
“I know better, but none of that was discussed at all,” Benac said.
LaPietra said that by spreading this message throughout the healthcare quorum in Manatee County, that will put pressure on the doctors not implementing safe prescription practices.
“If we are not part of the solution and our community is not stepping up to address it, then we are contributing to the problem and becoming silent,” LaPietra said.