Opioid bill, modeled after ALTO program at St. Joseph’s, passes in House

Effort to take N.J. program national moves one step forward, awaits action by Senate

By Anjalee Khemlani
Washington, D.C. | Jun 18, 2018 at 7:15 am

After more than a year of working on legislation that would decrease the use of opioids nationwide, the House of Representatives last week passed a bill to implement a pilot program modeled after the Alternatives to Opioids program that was created at St. Joseph’s Health.

St. Joseph’s Dr. Mark Rosenberg, who helped create the program, said it potentially could be a huge step in fighting the crisis.

“It’s important, because this bill is about prevention,” he said. “Other bills are about restricting the number of opioids that you give and making regulations about opioids. This is different. This provides physicians with new tools in the toolbox.”

The ALTO bill, sponsored by U.S. Rep. Bill Pascrell (D-N.J.), passed the House along with the Preventing Overdoses While in Emergency Rooms Act, sponsored by Rep. David McKinley (R-W.Va.).

A Senate version of the bill — sponsored by both Democratic New Jersey senators, Robert Menendez and Cory Booker — is still awaiting action.

The bipartisan effort to push a new method of addressing the opioid epidemic focuses on one simple change: not prescribing opioids.

Rosenberg lead a team that created and implemented the program in 2016, with support of CEO and President Kevin Slavin, and has seen overwhelmingly positive feedback and results.

Rosenberg said that, within the first three months, there was a 30 percent reduction in prescriptions. In the first six months, compared with prior implementation of ALTO, that rose to 46 percent.

The St. Joseph’s emergency department has been benchmarking the progress every six months, Rosenberg said.

And now, other departments are starting to use it.

The program has been rolled out in other states.

The bill called for a three-year pilot program to be funded by grants from the U.S. Department of Health and Human Services.

It also specifically directs the department to select awardees in differing geographical areas.

“This bill requires, and provides funds for, the Department of Health and Human Services to carry out a three-year demonstration program awarding grants to hospitals and emergency departments to develop, implement, enhance or study alternative pain management protocols and treatments that promote limited use of opioids in emergency departments,” according to the bill.

The timing of the bill’s passage coincides with a recent report from the Centers for Disease Control.

The report announced a new milestone: 200 people are dying from drug overdoses every day. Of those, 68 percent are dying from opioid overdoses.

New Jersey had the second-worst ranking of all states for opioid deaths, according to Opioid Watch.

The ranking is based on data from 2016 — the year Gov. Chris Christie pushed opioids as his biggest agenda item, spending $15 million on television commercials to promote awareness and prevention of opioid abuse.

“More troubling is the case of New Jersey, which endured the country’s second-worst overdose fatality hike — a 33 percent year-over-year increase for the period ending November 30, 2017,” according to Roger Parloff, editor-in-chief of the institute.

For the 12-month spans ending Sept. 31 and Oct. 31, New Jersey owned the nation’s worst increases, at 50 percent and 42 percent, respectively.

“New Jersey’s numbers are striking, because few American political figures have been as associated with the fight against drugs as New Jersey’s then-governor, Chris Christie, who last year chaired the President’s Commission on Combating Drug Addiction and the Opioid Crisis,” Parloff said.

Christie was succeeded as governor by Phil Murphy on Jan. 16.

While campaigning for the presidency in November 2015, Christie revealed — in speeches whose videos later went viral — how he had been personally touched by the epidemic, recounting how an admired law school classmate fatally overdosed on Percocet (oxycodone plus acetaminophen) and vodka.

Christie also signed into law a five-day limit on prescriptions, which doctors have said still leaves room for ambiguity.

Rosenberg said five days could mean more or fewer pills, depending on how frequently a patient should take them.

Which is why Rosenberg said the ALTO program has had so much success — it avoids the use of opioids altogether.

The next battle will be getting insurers on board to pay for the often-costlier alternatives, Rosenberg said.

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Anjalee Khemlani | akhemlani@roi-nj.com | AnjKhem