Page 150 - JSOM Spring 2018

Disclaimer contributed source information/data, and reviewed the manu-
The views expressed are those of the author(s) and do not re- script for clinical accuracy. KJN was directly involved in the
flect the official policy or position of the US Army Medical care of this patient, contributed source information/data, re-
Department, Department of the Army, Department of the Air viewed the manuscript for clinical accuracy, and participated
Force, Department of the Navy, Department of Defense, or the in the editing process. He is also the subject matter expert for
US Government. this manuscript with respect to orthopedic care. JP mentored
the other authors in manuscript preparation, participated in
Disclosures the editing process, submitted the manuscript, and takes re-
The authors have nothing to disclose. sponsibility for the manuscript’s overall content.

Author Contributions References
SS wrote the draft of this manuscript and participated in the 1. Shuett D, Hake M, Mauffrey C, et al. Current treatment strate-
editing process. PJA was directly involved in the care of this gies for patella fractures. Orthopedics. 2015;38:377–384.
patient, contributed source information/data, reviewed the 2. Boyd A, Benjamin H, Asplund C. Splints and casts: indications
manuscript for clinical accuracy, and participated in the edit- and methods. Am Fam Physician. 2009;80(5):491–499.
ing process. KK directly involved in the care of this patient,

Reducing the Prescription of Opioids in Emergency Departments

To help stem the opioid epidemic, the emergency depart- program, Shroff says that when he mainly treats bumps,
ment at St. Joseph’s University Medical Center in Paterson, bruises, and other musculoskeletal injuries, he does not
NJ, has been exploring the use of alternative painkillers prescribe a single opioid. He still finds that “unbeliev-
and methods. This approach has led to a 58% decrease in able,” he says.
the emergency department’s opioid prescriptions during
the first year, according to St. Joseph’s Healthcare Sys- One challenge has been is the cost of using alternatives
tem’s Chair of Emergency Medicine, Dr Mark Rosenberg. to opioids. Sometimes, physicians had to work with phar-
macists to find more affordable “alternatives to the alter-
“There is a complete change in philosophy, a complete natives.” For example, instead of prescribing lidocaine
change in culture in the department,” says Rosenberg, patches for patients to put on at home, physicians have
who launched the Alternatives to Opiates program in switched to lidocaine ointment or cream, which is often
2016 with Dr Alexis LaPietra, the medical director of pain covered by insurers. “The insurance companies don’t em-
management in the emergency department. brace all the alternative treatments and instead would
rather frequently have us prescribe opioids because they
“We have to go back to times when things were a little tend to be inexpensive and readily available.”
more simple,” LaPietra says. “Those easy, at-home tech-
niques—good patient education, really—they help a lot Other emergency departments have rolled out alterna-
with some of that pain that patients have to deal with tives to opioids at a smaller scale. But the model that
when they go home.” St. Joseph’s has developed is now being copied at other
facilities.
This new policy requires a culture change.
[Reported by HANSI LO WANG on February 20, 20181:02
“It took a little bit of getting used to,” says Dr Ninad PM ET and heard on NPR’s “All Things Considered.” The
Shroff, an attending physician in St. Joseph’s emergency full story is available at https://www.npr.org/sections
department. “I’ve been doing this for about 20 years, /health-shots/2018/02/20opioid-use-by-more-than-half
so for me, it was a big change.” But at 2 years into the -with-dry-needles-laughing-gas].

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