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

doi:10.1177/08971900231189353

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

J Pharm Pract. 2023 Jul 12:8971900231189353. doi: 10.1177/08971900231189353. Online ahead of print.

Authors

Steven F Nerenberg¹, Caitlin E Kulig^{1

2}, Alexis M LaPietra³, Osama A Elsawy⁴, Antai Wang⁵, Lindsey A Foran⁴, Ahmad F Hlayhel⁴, James Yang⁴, Dinesh Parmar⁶, Jackie P Rowe^{1

2}

Affiliations

¹ Department of Pharmacy, St. Joseph's University Medical Center, Paterson, NJ, USA.
² Department of Pharmacy Practice and Administration, Rutgers, The State University of New Jersey, Piscataway, NJ, USA.
³ Department of Emergency Medicine Services, RWJBarnabas Health, West Orange, NJ, USA.
⁴ Department of Surgery - Trauma Division, St. Joseph's University Medical Center, Paterson, NJ, USA.
⁵ Department of Mathematical Sciences, New Jersey Institute of Technology, Newark, NJ, USA.
⁶ Department of Anesthesia, St. Joseph's University Medical Center, Paterson, NJ, USA.

PMID: 37438883
DOI: 10.1177/08971900231189353

Abstract

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 (ALTO^SM) 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. ALTO^SM was not associated with less in-hospital or discharge opioid prescribing.

Keywords: analgesia; opioid; pain management; trauma.