The way New Jerseyans are being treated for pain in the emergency department is changing, and the gold-standard of care is assessing patients for opportunities to use appropriate alternatives to opioids.
The Opioid Reduction Options (ORO) in the Emergency Department (ED) program helps doctors, nurses, pharmacists and care team members treat people’s pain while reducing the risk of opioid addiction.
Prescriptions for opioids decreased 6 percent during 2019, a sign that the healthcare community is taking its role in preventing opioid addiction seriously. But there is still more work to be done in making sure patients are not needlessly put at risk.
The New Jersey Department of Health and the Department of Human Services have partnered with the New Jersey Hospital Association and St. Joseph’s Health to implement ORO by providing training to doctors, nurses and other practitioners on when prescribing opioids is appropriate, as well as alternatives to opioids when they are not the best course of care. The goal is to reduce the rate of ED patients receiving opioid prescriptions to 12 percent or lower.
How does it work? When a patient comes into the ED in pain, medical teams use a patient’s health history and specific complaint to identify the most appropriate course of pain management. They use a series of decisions (called an algorithm) to find the most effective pain management technique or drug with the fewest side effects.
A patient’s pain is a serious part of care and will be addressed, but patients should not be surprised when opioids are not the first option for treatment. There are a very small number of exceptions where opioids are considered the best form of pain management, including patients with cancer and end-of-life care needs, and these patients will be treated appropriately.
Hospitals in the ORO program are not opioid-free – opioids will be prescribed when they are the appropriate course of treatment.
What are some of the options?
- Tylenol and Ibuprofen combinations
- Topical pain relief, in the form of a patch or a cream
- Nitrous oxide, otherwise known as laughing gas
- “Local” pain relievers, targeted at a specific painful place on the body
- Counseling, massage, meditation and/or yoga for chronic pain.
Why are these changes being made? The opioid epidemic claimed 351,630 lives between 1999 and 2016, starting with the initial spike in synthetic opioid prescriptions when pain relievers were incorrectly marketed to doctors and patients as nonaddictive. There is evidence that many people who became addicted – and overdosed – on opioid drugs started with use of a prescription medication. The first rule of medicine is “Do No Harm”; by reducing patient risk of addiction hospital EDs are following that rule.
What can you do to avoid unnecessary opioid prescriptions? Talk to your doctor or nurse about your pain concerns and ask if you are a candidate for an alternative pain management option. Be open to working with your healthcare team to find the best possible solutions for you.
If you or a loved one needs help accessing opioid addiction treatment, call 844-REACH-NJ to connect to a live counselor. Columnist Mary Ditri, DHA, is the vice president of community health at the New Jersey Hospital Association.
