Effect of Alternatives to Opiates Program on Discharge Opioid Prescribing in Trauma Patients

Steven F. Nerenberg, Caitlin E. Kulig, Alexis M. LaPietra, Osama A. Elsawy, Antai Wang, Lindsey A. Foran, Ahmad F. Hlayhel, James Yang, Dinesh Parmar, Jackie P. Rowe

Research output: Contribution to journalArticlepeer-review


Background: Opioid overdose deaths have increased over the last two decades, despite efforts to reduce prescribing. This study aimed to determine if a hospital-wide Alternatives to Opiates (ALTOSM) program reduced opioid prescribing in hospital and upon discharge after trauma. Objectives: The primary outcome was incidence of opioid prescribing at hospital discharge Pre- and Post-ALTO. Secondary outcomes were the percent of patients with in-hospital opioid, non-opioid and multimodal analgesia, and hospital and intensive care unit (ICU) length of stay (LOS). Methods: This is a single-center, retrospective analysis of patients >/ = 18 years old admitted for >24 hours with the primary diagnosis of traumatic injury between August 2018 - October 2019. Patients with alcohol or polysubstance abuse, chronic opioid use, or in-hospital mortality were excluded. Results: A total of 703 patients were included, 471 in Pre-ALTO and 232 in Post-ALTO groups. The mean age was 59 ± 22 years and most were male (58.7%). Mean initial Injury Severity Score (ISS) was 9.1 ± 7.7. Opioid prescribing at hospital discharge occurred more in the Post-ALTO group (132/332, 39.4% vs 90/203, 43.8%; P =.1237). Most patients were prescribed in-hospital opioid (332/471, 70.4% vs 203/232, 87.5%, P <.0001) and non-opioid (441/471, 93.6% vs 229/232, 98.7%; P =.0027) analgesics, or multimodal analgesia (397/471, 84.3% vs 203/232, 87.5%; P =.2591). Median hospital and ICU LOS were also similar between groups [5 (3-9) vs 4(3-7), P =.3427] and ICU [2(0-4) vs 3(2-5), P =.3461]. Conclusion: Opioids remain mainstay for trauma-related pain treatment. ALTOSM was not associated with less in-hospital or discharge opioid prescribing.

Original languageEnglish (US)
JournalJournal of Pharmacy Practice
StateAccepted/In press - 2023

All Science Journal Classification (ASJC) codes

  • Pharmacology (medical)


  • analgesia
  • opioid
  • pain management
  • trauma


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