U.S. Rep. Bill Pascrell, Jr. (D-NJ-09) is leading an official request to fund the Alternative to Opioids (ALTO) Demonstration program at $10 million for Fiscal Year 2022. The federal program was established by Rep. Pascrell’s Alternatives to Opioids in the Emergency Department Act, which was enacted into law in 2018. The bipartisan funding request letter was also signed by Reps. Diana DeGette (D-CO-01), David B. McKinley (R-WV-01), and Brad Wenstrup (R-OH-02).

“As the subcommittee begins its work on the Fiscal Year (FY) 2022 Labor, Health and Human Services, and Education Appropriations bill, we respectfully request that you include $10 million for the Alternatives to Opioids (ALTO) Demonstration program,” the Members wrote to the leaders of the House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies.

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, 130 people on average die every day due to an opioid-related drug overdose. In 2018 alone, over two-thirds of the more than 67,000 overdose deaths involved an opioid. In addition, more than 2 million people have an opioid use disorder.

The ALTO Demonstration program is modeled on an initiative pioneered by St. Joseph’s Medical Center in Paterson, New Jersey that reduces the use of opioids in emergency departments. Rep. Pascrell was the primary sponsor of H.R. 5197 which established the demonstration program and has worked to increase annual funding for the program since its enactment.

The full text of the members’ letter is provided below.

April 26, 2021

Dear Chairwoman DeLauro and Chairman Cole:

As the subcommittee begins its work on the Fiscal Year (FY) 2022 Labor, Health and Human Services, and Education Appropriations bill, we respectfully request that you include $10 million for the Alternatives to Opioids (ALTO) Demonstration program. This program and funding level was authorized by the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act (P.L. 115-271).

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, 130 people on average die every day due to an opioid-related drug overdose. And in 2018 alone, over two-thirds of the more than 67,000 overdose deaths involved an opioid.^[i] In addition, more than 2 million people have an opioid use disorder.^[ii]  Through legislation like the SUPPORT Act, Congress has taken bold steps to combat this crisis.

Emergency departments are in a unique position to combat the opioid epidemic, as pain is one of the most common reasons for admission. Recognizing this, emergency departments in several states have developed innovative programs with protocols that utilize non-opioid pain treatments to reduce the use of opioids.

Programs within our states are either ongoing or currently being implemented. The emergency department at St. Joseph’s University Medical Center in Paterson, New Jersey launched an ALTO program in 2016, where in 2020, the last pre-COVID-19 discharge opioid prescription rate was 3.5%. Nationally, the average rate across emergency departments is closer to 17%. 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. In November 2020, Colorado’s UCHealth system, which includes 12 hospital-based emergency departments (EDs) who cumulatively serve approximately 500,000 ED visits per year, started an ED alternative to opioids project. The project uses electronic health record clinical decision support interventions alongside education to decrease opioid exposures, both in the ED and upon discharge, and achieve pain relief with non-opioid alternatives. West Virginia hospitals have been engaged with the West Virginia Hospital Association (WVHA) in efforts to improve opioid stewardship and access to opioid use disorder treatment since 2018 with the launch of the WVHA Opioid Collaborative. Prior to the COVID-19 global public health emergency, 31 acute care hospitals committed to participate in a focused 12-month project to implement an Alternatives to Opioids (ALTO) Project in their Emergency Departments. The project goal is to reduce the administration of opioids in the emergency department by increasing the reliance on alternatives to opioids. In September 2020, ProMedica started implementing an ALTO project at two emergency departments in Lucas County, Ohio. At the conclusion of the project in August 2023, ProMedica aims to achieve a 45 percent reduction in opioids given in the emergency departments, reaching an estimated 8,000 patients.

Section 7091 of the SUPPORT Act directs the Secretary of Health and Human Services to conduct a demonstration program that will facilitate the adoption of ALTO programs in hospitals and emergency departments throughout the country. The SUPPORT Act includes a $10 million authorization for the ALTO Demonstration, which was funded at $5 million each in FY20 and FY21. We respectfully request that the committee fully fund this important program for FY22.

Thank you for your consideration of this request. 

Sincerely,