WASHINGTON, DC – Today, U.S. Senators Cory Booker (D-NJ) and Shelley Moore Capito (R-WV) introduced legislation to reauthorize the Alternatives to Opioids (ALTO) in the Emergency Department program at $10 million annually over five years. The ALTO program was created in 2018 by Booker and Capito-led measure in the Senate that was included in the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act (P.L. 115-271). Companion legislation has been introduced in the House by Representatives Bill Pascrell, Jr. (D-NJ-09), David McKinley (R-WV-01), Diana DeGette (D-CO-01), and Brad Wenstrup (R-OH-02).


“Successfully addressing the devastating effects and unimaginable pain caused by the opioid epidemic requires a holistic and innovative response such as the one pioneered by St. Joseph’s Medical Hospital in New Jersey for years,” said Sen. Booker. “I’m proud to introduce legislation that will ensure St. Joe’s innovative program can continue to be a blueprint of success for communities, helping us reduce the number of opioid prescriptions written in emergency rooms across our nation.” 


“Last year, we lost more Americans than ever before to drug overdoses, and it’s another reminder that we need to redouble our efforts to curb the addiction crisis in our country,” said Sen. Capito. “Doing so requires an all-hands-on-deck approach and the ALTO in the Emergency Department Act is a tool that will help in this fight. Millions of opioid prescriptions are written each year, and a significant portion of opioid overdose deaths involve these prescription opioids. There are alternatives to treating pain that can help save lives, and that is exactly what our bill aims to do. By helping to explore non-opioid pain treatments, I am hopeful this bill will help decrease opioid usage in West Virginia.”


“The ALTO program we created is an essential tool in our longstanding fight against the opioid crisis. We must continue to fund this lifesaving program with every dollar it needs,” said Rep. Pascrell, the primary House sponsor of H.R. 5197 which established the ALTO demonstration program. “Since 2018, our ALTO legislation has provided a ground-breaking preventative blueprint for hospitals and health care providers across America as they grapple with the opioid epidemic. This program is progressive and forward-looking. Most importantly, it will protect American lives.”


“Promoting alternatives to highly-addictive opioid painkillers will reduce addiction and abuse, and ultimately save lives,” said Rep. McKinley. “We worked to include this program in the 2018 opioids bill, and now we need to follow through with adequate funding. Recent reports show opioid overdose deaths increased 40% during 2020, largely driven by the powerful synthetic opioid fentanyl. We must do more. ALTO helps stop opioid addiction before it even starts by focusing on patients in the ER.”


"This program will save lives,” said Rep. DeGette. “The ALTO program is based off innovative, science-based approaches that have shown to effectively help our health care system curb the use of prescription opioids in this country. These types of programs are precisely what we need in hospitals and emergency departments across the country to help curb the nation's opioid epidemic."


“Emergency physicians on the frontlines of the opioid epidemic can attest firsthand at the proven success of the Alternatives to Opioids (ALTO) program,” said Dr. Mark Rosenberg, DO, MBA, FACEP, President of the American College of Emergency Physicians (ACEP)  and Chairman of Emergency Medicine; Chief, Innovation Officer of St. Joseph’s Health in Paterson, New Jersey. “As our communities and families confront the challenge of  opioid use disorder (OUD), the bipartisan ALTO in the Emergency Department Reauthorization Act of 2021 will better equip us with the tools we need to help our patients and communities struggling with opioid use disorders–and most importantly–prevent OUD before it even starts. Personally, I am proud and grateful to continue working with my friends, Representative Pascrell and Senator Booker, to reauthorize this lifesaving program that we originally began right here in New Jersey, and also thank Representative McKinley and Senator Capito for their continued bipartisan leadership on this bill. On behalf of ACEP, I extend our deepest thanks for their tireless efforts to ensure that more Americans have access to the appropriate care they need and deserve.”


“St. Joseph’s University Medical Center commends Rep. Pascrell for introducing this critical legislation. Reauthorizing the Alternatives to Opioids in the Emergency Department program will allow emergency departments across the nation to implement or expand programs that treat acute pain without the use of opioids. The Emergency Department at St. Joseph’s University Medical Center was the first in the United States to launch an Alternatives to Opiates Program (ALTO), and the results have been exceptionally promising. Since the program’s inception in 2016, up to 75% of St. Joseph’s patients have achieved adequate pain relief with alternative therapies and there has been a decrease in opioid use by almost 50% since the inception of the program. Section 7091 of the Support for Patients and Communities Act (Pub. L. 115-271) took ALTO nationwide. As a result, programs across the country have received the funding and resources they need to implement their own programs. St. Joseph’s University Medical Center applauds Rep. Pascrell for introducing legislation to reauthorize this important program for another five years. We also wish to recognize Reps. Diana DeGette (D-CO), David McKinley (R-WV), and Brad Wenstrup (R-OH), the bill’s bipartisan lead cosponsors,” said Kevin Slavin, CEO of St. Joseph’s Health.


In 2020, the Substance Abuse and Mental Health Services Administration (SAMHSA) awarded $4,750,000 to ten hospitals and emergency departments across the country for ALTO Demonstration Program. The legislation introduced today will make ALTO a permanent program and provide funding for more hospitals and emergency departments to develop and implement alternatives to opioids for pain management.


As a first line of defense for combatting the opioid epidemic, emergency departments are well-positioned to be laboratories of new innovations to combat the crisis. Eager to try fresh approaches to address the epidemic, the team at St. Joseph’s Medical Center in Paterson, New Jersey, led by its director of emergency medicine, Dr. Mark Rosenberg and CEO Kevin Slavin, created the ALTO program. ALTO utilizes non-opioid protocols instead of painkiller prescriptions to treat acute pain. St. Joseph’s launched its ALTO program in 2016, and two years later the number of opioid prescriptions written had decreased by more than 80 percent. In January 2020 alone, St. Joe’s engaged 80 people in the emergency department for recovery support services for opioid use disorder and the hospital is also dispensing Narcan kits for patients who are at high risk for opioid overdose. The model has been so successful that St. Joseph’s has expanded the protocol to other departments within the hospital, and Dr. Rosenberg has travelled the country helping other health systems get ALTO programs up and running.


The opioid epidemic continues to claim the lives of thousands of Americans throughout the United States. According to the Centers for Disease Control and Prevention, drug overdose deaths in the United States rose 29.4% in 2020 to an estimated 93,331, including 69,710 involving opioids. In addition, more than 2.2 million people have an opioid use disorder.


This legislation is supported by the American College of Emergency Physicians, America’s Essential Hospitals, and St. Joseph’s Health of Northern New Jersey.