In December 2019, Congress authorized funding for the Alternatives to Opioids (ALTO) in the Emergency Department program—the final step in the legislative process needed to set the ALTO grant program in motion and another significant victory for ACEP’s federal advocacy efforts.

Background

The ALTO program was originally developed by ACEP President-Elect Mark Rosenberg, DO, MBA, FACEP, and Alexis LaPietra, DO, FACEP, and their team at St. Joseph’s University Medical Center in New Jersey in 2016. Intended to address issues of variation and overprescribing of opioids, ALTO is an evidence-based, multidisciplinary acute pain management program that helps treat painful conditions for patients in the emergency department without using opioids and also helps other patients who may have an opioid use disorder (OUD). In just one year after implementing the program, opioid prescriptions in the St. Joseph’s emergency department fell by 46 percent, and after two years, opioid prescriptions were down by 82 percent.

ACEP’s federal advocacy efforts to help expand the reach of the ALTO program began in 2017, and the path from introduction to authorization and appropriations was extraordinarily rapid by legislative standards. ACEP’s Washington, D.C., staff worked with Rep. Bill Pascrell (D-NJ) and Rep. David McKinley (R-WV), as well as Sen. Cory Booker (D-NJ), Sen. Shelley Moore Capito (R-WV), Sen. Michael Bennet (D-CO), and Sen. Cory Gardner (R-CO) to develop legislation that would establish a federal grant program to provide $10 million per year to help other emergency departments implement their own ALTO protocols.

On March 7, 2018, the Alternatives to Opioids in the Emergency Department Act was introduced in both the House and Senate (HR 5197/S 2516)—fortunately timed, as all of Congress’ attention was squarely focused on the nation’s opioid epidemic. ACEP received an invitation to testify about the ALTO program’s success before a House Committee on Energy & Commerce hearing on March 22, 2018, and Dr. Rosenberg testified on ACEP’s behalf. ACEP members advocated for ALTO during the annual Leadership & Advocacy Conference, and the bill was included among a number of other opioid-related bills that were marked up in the Energy & Commerce Health Subcommittee in April and the full committee in May. ALTO received a voice (unanimous) vote on the House floor in June, and it was then merged into the SUPPORT for Patients and Communities Act (HR 6), which was ultimately signed into law on Oct. 24, 2018. The ACEP-developed ALTO legislation went from introduction to enactment in a mere eight months.