Opioid stewardship meets real-world workflow: How one ED makes it work
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We’re starting to do more and more nerve blocks in the ER. It’s quick, easy, and it works for hours and hours.
—Luke Weber, MD
If you’ve ever handed off a patient in acute pain and felt that familiar tug-of-war—effective analgesia vs opioid stewardship—you’re not alone.
CNN’s recent special, “Dr. Sanjay Gupta Reports: It Doesn’t Have to Hurt,” drops straight into the center of that tension, spotlighting a Brooklyn emergency department that’s quietly rewriting the rules.
And honestly? It’s compelling.
Related: This breakthrough pain drug provides opioid-like relief—without the risks and side effectsA different kind of pain playbook
The cameras followed Dr. Gupta into Maimonides Medical Center, the largest hospital in Brooklyn, where emergency physicians aren’t debating whether to reduce opioid use—they already have. This ER is practicing something they call “opioid optimization.”
Luke Weber, MD, an ED physician, put it plainly when Dr. Gupta asked him whether opioids remain the therapy of choice: "Opioids is one of our therapies, but we take a lot of pride here in offering a wide variety of pain modalities."
Translation: Opioids aren’t gone—they’re just no longer first in line. The architect of this shift is Sergey Motov, MD, an ED physician and research director. His framework is deceptively simple: Use non-opioid analgesia as the primary therapy, with opioids reserved only as a rescue—and only with patient consent.
This isn’t just a philosophical pivot; it’s now standard operating procedure, and Dr. Gupta notes that most patients are satisfied.
Nerve blocks in the ER
When Dr. Gupta asked Dr. Weber for an example of what’s replacing opioids, Weber didn't hesitate: nerve blocks. Not in perioperative suites. Not under anesthesia consult. Right there in the emergency department.
“We’re starting to do more and more nerve blocks in the ER,” Dr. Weber said. “It’s quick, easy, and it works for hours and hours." The hospital has also built an entire nerve block team—on-call, trained, and ready.
The CNN special introduced Joseph, a 76-year-old with a broken hip. In most EDs across the United States, he’d be given opioids. At Maimonides, he gets a femoral nerve block. Less than 10 minutes later, Joseph is essentially pain-free.
Dr. Gupta said what many of us are thinking: "That’s kind of incredible because I think the knee-jerk response when you get somebody [who] comes in with a fracture, probably getting opioids—at least that’s what I heard.”
Dr. Weber agreed with his assessment: “You’re absolutely right … We’re really trying to kind of change that paradigm.”
Related: 6 therapies for managing pain without opioidsWhy this matters for clinicians everywhere
Many EDs have embraced multimodal pain management, but Maimonides is operationalizing it at scale—and showing that it can be done without slowing throughput or decreasing patient satisfaction.
What stands out:
Non-opioid-first isn’t just an ideal; it’s functional. Clear protocols and trained staff make alternatives immediately deployable.
Nerve blocks are feasible in the ER. They require training, yes, but not an anesthesiologist. Dr. Gupta’s report highlighted how quickly they can be administered and how dramatically they change pain trajectory.
Patients appreciate options, not just medications. Dr. Motov stresses that patient agreement is central. And that satisfaction remains high, even when opioids aren’t the first-line reflex.
Whether you practice emergency medicine, orthopedics, or primary care, the message is clear: Opioid-sparing care isn’t about withholding—it’s about expanding.
And when an ER can reduce opioid use while keeping patients comfortable—even in cases like hip fractures—it suggests that scalable multimodal strategies might be more within reach than many clinicians assume.