Tucker Woods, DO, is the Chief Medical Officer at CarePoint Health-Christ Hospital in Jersey City. Dr. Woods also provides oversight for the three CarePoint Health Emergency Departments.
You oversee the emergency departments at CarePoint Health and are making a push to reduce the use of opioids in emergency care. How much of the problems linked to the current opioid epidemic is connected to emergency care?
I actually think the ER plays a small role in the overall epidemic. These are unscheduled visits from people who will come with an acute problem, say a broken ankle, or perhaps a burn. In these settings, it’s appropriate to treat that pain properly with a short course of pain medication. Yet in terms of the overall problems in the nation related to opioids, all of us in health care play a role. In the emergency department, we wanted to come up with alternatives to treat pain effectively for our patients but not contribute to the opioid epidemic.
Are there effective alternatives for people in pain that do not require opioids?
Yes. We can actually provide medication that is more effective in pain control than opioids and that is not addictive. We have developed a menu of different medication options and call our pain program STOP—Shifting The Opioid Paradigm. Let’s say someone comes in with a broken wrist or shoulder. Previously, we would provide opioids — such as an injection of morphine. Now we can offer nitrous oxide, or “laughing gas.” It kicks in immediately and wears off quickly. If a patient comes in with a kidney stone, we previously would have given a non-steroidal (NSAID) injection plus an opioid.
Now, if the same kidney stone patient doesn’t have pain control with the NSAID, we give intravenous lidocaine instead of the opioid. That’s a medicine we use a lot with skin lacerations — injecting it locally to numb the skin. But we’ve learned that for kidney stones it works quickly and is even safe in pregnancy. Another example is lower back pain. Instead of giving opioids, we give Tylenol plus an NSAID plus Lidoderm patch and maybe a muscle relaxer. Sometimes we use trigger point injections as well. We know that if someone goes home with back pain zonked out on opioids they stay in bed for days on end. They get worse …. and constipated. So we are using a much more practical approach that gets patients better sooner.
Are patients happy with this approach, or are they expecting opioids?
As long as the patients see their pain improve, they are happy. Overall it has been a positive experience for our patients. If a patient does request an opioid — maybe they say, “Hey, two years ago you gave me morphine” — then we have a conversation. We say we have something better that’s not addictive. That won’t make you constipated. They get it.
What about patients who already are addicted and are coming to the ER for an opioid prescription?
That happens. I think the law signed under Gov. Christie that requires doctors to counsel patients before prescribing opioids has helped. That was positive. In the ER, if we see someone who already is addicted we will talk to him or her about detox and other options. And we will say, “We can treat your pain, but we can’t give you opioids.”
On a personal note, what was it about emergency medicine that attracted you to the specialty?
I got into medicine because I wanted to make a difference. And in emergency medicine, you really do make a difference. You see people with unexpected illnesses and conditions. I was afraid if I saw the same thing every day I would eventually get burned out. I have been in emergency medicine since 1995, and every day is different. There are days when you literally are saving lives and that is very rewarding.