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What Does It Take To Be Opioid-Free?

It seems not a day goes by without hearing or reading about the dangers associated with opioids. As nurse practitioners, you know that these medications can be vital to pain treatment. You also know that managing an opioid regimen is complex.

Everyone from the surgeon general to the Centers for Disease Control and Prevention to the Food and Drug Administration has issued national calls to reduce opioid prescribing. One hospital decided to halt it altogether.

As we reported recently on the ADVANCE for NPs & PAs website, St. Joseph's Regional Medical Center in Paterson, N.J., is the first hospital in the nation to stop providing opioids in its emergency department. The facility developed the Alternatives to Opiates (ALTO) program, which it describes as "a highly successful, unique, alternative approach to acute pain management without the use of opioids and the potential addictions associated with opioid use."

The St. Joseph's emergency department launched the ALTO program in January 2016. Within the first month, 250 patients were treated with alternative protocols and did not receive opioids when previously they would have. ALTO utilizes targeted non-opioid medications, trigger point injections, nitrous oxide and ultrasound-guided nerve blocks to manage patient pain whenever possible.

When we posted a link to this article on the ADVANCE for NPs & PAs Facebook page, it generated a cavalcade of reaction, mostly critical in nature: "I think that's irresponsible. Some people legitimately need opioids in the ER," wrote one Facebook poster. "Barbaric!" declared another.

This month's continuing education article explores this issue in depth: How can providers manage severe pain without opioids? The author of the article, Brett Badgley Snodgrass, FNP-C, CPE, FACPP, FAANP, is the director of clinical operations at LifeLinc Pain in Memphis and was the first nurse practitioner in the United States to become a fellow of the Academy of Integrative Pain Management as an advanced credentialed pain practitioner. She explains that individualizing therapy based on the type and nature of pain is imperative, and that it's equally important to consider a multidisciplinary approach in the form of medication management, rehabilitative therapies, psychological interventions and more. I think you will find this article eye-opening and useful to practice.

Contact me with your thoughts on pain management and the appropriate use of opioids at

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