Non-opioid alternatives: NJ docs creating fewer opportunities for addiction
As New Jersey continues efforts to gain ground in its battle against a drug overdose epidemic, medical professionals throughout the state are doing their part by treating opioids as a last resort in many cases of acute and chronic pain.
In the face of thousands of overdose deaths on a yearly basis, advocates and officials in New Jersey have been touting non-opioid alternatives in health care settings as one approach to keeping opioid-naive individuals from ever having the opportunity to become addicted.
In early 2023, health care professionals suggest the "alternative" route is prevalent in the Garden State, with the culture of prescribing looking very different today compared to just a few years ago.
"I cannot even tell you the last time I prescribed an opioid for an outpatient complaint," Dr. Katherine Vlasica, medical director of emergency medicine pain management at St. Joseph's Health, told New Jersey 101.5.
The Paterson facility in 2016 was the first in the nation to implement the Alternatives to Opiates Program. It uses non-opioid medications, trigger point injections, ultrasound-guided nerve blocks, and other measures to handle pain related to kidney stones, broken bones, migraines, and acute low back pain.
"What we have found is that there is a very deep bench between Motrin and morphine, and we have really gotten to know all the players on that bench really well," Vlasica said.
Since the program's launch, representatives from St. Joseph's have visited other hospitals in New Jersey to hold training sessions on the topic of non-opioid alternatives, Vlasica said.
Figures are still being finalized, but it's expected that 2022 will end up being the first year since 2017 with fewer than 2,900 overdose deaths in New Jersey.
As of November, close to 3.1 million opioid prescriptions had been written in 2022 throughout the state.
Since 2017, New Jersey has required that prescribers discuss the risks and benefits of opioid treatment with their patients suffering from acute pain, as well as non-opioid alternatives, before issuing an initial prescription. The prescription must be no more than a five-day supply at the lowest effective dose of an immediate-release drug.
"The number of providers within the state that are well versed with these alternatives ... is leaps and bounds ahead compared to where we were," said Dr. Michael Sabia, a member of the Medical Society of New Jersey and a pain medicine specialist at Cooper University Hospital in Camden.
"We know it's not just the severity or the level of the pain. It's more the nature — is it burning, is it sharp, is it throbbing? What medication works on that receptor?" Sabia said.
There is still a role for opioids in the health care process, Sabia noted — not every patient will respond successfully to alternatives. But opioids don't provide targeted relief; other medications can provide relief to a very specific site.
As momentum toward alternatives steadily grows, Sabia added, health care professionals are waiting on insurance companies to play catch up and cover more research-supported non-opioid medications.
"Some patients do wind up on opioid therapy when they don't need to be," he said.