Emergency Department Alternatives to Opioids: Adapting and Implementing Proven Therapies in Practice

Sarah B. Floyd (), Sam NcGarby, Susan Cordero Romero, Sam Garrison, Kevin Walker, William Hendry and Phillip C. Moschella
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Sarah B. Floyd: Department of Public Health Sciences, Clemson University, Clemson, SC 29631, USA
Sam NcGarby: Department of Emergency Medicine, Prisma Health-Upstate, Greenville, SC 29605, USA
Susan Cordero Romero: Department of Emergency Medicine, Prisma Health-Upstate, Greenville, SC 29605, USA
Sam Garrison: Department of Public Health Sciences, Clemson University, Clemson, SC 29631, USA
Kevin Walker: Division of Pain Management, Prisma Health-Upstate, Greenville, SC 29605, USA
William Hendry: Integrated Health Partners, Greenville, SC 29609, USA
Phillip C. Moschella: Department of Emergency Medicine, Prisma Health-Upstate, Greenville, SC 29605, USA

IJERPH, 2023, vol. 20, issue 2, 1-13

Abstract: The use of opioids to treat pain can increase the risk of long-term opioid dependency and is associated with negative patient outcomes. The objective of this study was to present the initial results following the implementation of Emergency-Department Alternatives to Opioids (ED-ALTO), a program that encourages the use of non-narcotic medications and procedures to treat pain in the Emergency Department (ED). We used a pre- and post-implementation study design to compare in-ED opioid utilization, as well as ED-ALTO medication and procedure use in the year before and after the program’s implementation. After ED-ALTO’s implementation, there was a decrease in opioid utilization in the ED and an increase in ED-ALTO medication use. Additionally, there was an increase in ED-ALTO procedure utilization and the complexity of conditions treated with ED-ALTO procedures, including the use of regional nerve blocks for shoulder dislocations and hip and rib fractures. In 8 of the 12 months following ED-ALTO’s implementation, a lower proportion of patients receiving ED-ALTO procedures received an opioid, and the opioid dosage was lower compared to patients with the same diagnoses who received standard care. The continued expansion of ED-ALTO programs across the US may serve as a mechanism to reduce opioid utilization and safely and successfully treat pain in ED settings.

Keywords: opioid; analgesic; emergency medicine; emergency department; pain management (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2023
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