There's a new tool for battling the opioid epidemic, compressed inside long, metal tanks at an emergency room in Paterson, N.J.
It's laughing gas, also known as nitrous oxide.
If you think this is a joke, spend a few hours with Alexis LaPietra, medical director of pain management at St. Joseph's Regional Medical Center's emergency department. She's developed an opioid-alternative program that's trying out unusual ways to help patients through their pain without using prescription painkillers in the ER, where the road to addiction began for many patients.
"What we've been doing before didn't have the best results," LaPietra says. "Let's try a different way besides pills, which I know are easy to take. But they have risks."
Risks of overdose and sometimes death drove the Centers for Disease Control and Prevention to put out national guidelines in March, calling for physicians to consider alternatives to opioids first when treating pain.
"We are really trying to move outside the box because we don't want our patients to suffer. We cannot allow this to continue," she says.
To relieve fractures, St. Joseph's ER now uses ultrasound to find nerves that can be injected with a numbing agent to block the pain. LaPietra says she's also encouraging patients to try treatments such as acupuncture after they're discharged from the hospital.
Dr. Jeanmarie Perrone, a professor of emergency medicine at the University of Pennsylvania, studies how emergency departments prescribe opioids. She says this opioid-alternative program is a step in the right direction as other hospitals have tried similar efforts at a smaller scale to cut back on opioids.
"This requires a balancing act," Perrone says. "This is the art of medicine. This is the appropriate use of our judgment."
She warns, though, that this shift goes against a longstanding culture amongst many physicians.
"All we've really been told is, 'Make sure that you've treated pain adequately so that the patient thinks that their pain is well-controlled,' and that that translates into treating them with an opioid and as much as they want."
Perrone says hospitals that try opioid-alternative programs in their ERs may risk getting more negative patients reviews about how they manage pain.
"The point here is not to be for or against opioids any more than it makes sense to be for or against antibiotics," says John Markman, a neurologist at the University of Rochester who specializes in pain management.
He says any ER's pain management program still has to keep opioids as an option.
"The goal is to learn to use them skillfully to minimize the public health risks because the public health risks are significant," says Markman, who's conducted research on opioids, some of which was funded by pharmaceutical companies. "There are many patients in the right context and in the right hands who can benefit."
That's a reality for some cancer patients and other people with severe pain that Mark Rosenberg, chairman of St. Joseph's emergency department, acknowledges.
"We are not opioid-free," he explains. "Even though it's alternatives first, we will use whatever pain medication we need to improve the care of the patient."
Among the 300 patients from the first two months of St. Joseph's program, Rosenberg says 75 percent left the ER without needing opioids.
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