ALTO program will become key national effort as Trump signs opioid act

With President Donald Trump’s signing of the bipartisan STOP Act to help curb the opioid epidemic last week, the Alternatives to Opioids program developed in New Jersey has become one of the key efforts the country will look to.

But it’s just Step One, according to Dr. Mark Rosenberg.

“The work is not over,” he said.

Rosenberg, chairman of emergency medicine at St. Joseph’s Health — who develop the program also known as ALTO with the help of Dr. Alexis LaPietra, medical director of emergency department pain management — said the federal government still has a lot to figure out in terms of implementing all the provisions of the STOP Act.

Meanwhile, he continues to get calls for information and lectures at the state level.

“What’s interesting is the response of many states … in particular in New Jersey, Nevada and Colorado, who want to roll out ALTO as a statewide initiative,” Rosenberg said.

“So, we have the federal piece, which is creating a framework and a structure, but we have the individual states, which have huge opioid problems, who want a solution to fix it.”

In fact, Rosenberg said, he’ll be in Nevada soon to train physicians on the ALTO principles and not only prevention of, but also treatment of substance use disorders.

It’s a significant paradigm shift even within his own workplace.

After its success in the ER, OB/GYN also picked up on the program. Now, the dental department has picked it up and internal medicine is interested, Rosenberg said.

But external factors are still an obstacle.

While pharmaceutical companies are putting greater focus on developing alternatives, it will still be some time before the market sees the products, Rosenberg said.

And insurance and pharmacy benefits managers are still favoring cheaper opioids for patients rather than trying to push the safer, but more expensive, alternatives.

At least there are steps being taken in the right direction, Rosenberg said.

He likened the epidemic to the HIV/AIDS outbreak. There, too, a generation was being wiped out.

“Putting it in that framework, I think if we go forward a decade, what I see is, ALTO has made a difference in stemming the tide and saving lives,” Rosenberg said. “So, this is the next step.”

The STOP Act also includes provisions to track dangerous substances like fentanyl through the U.S. Postal Service, and it dedicates more than $60 million to aid in treatment and prevention services in the hardest-hit states.

Read more from ROI-NJ on ALTO: