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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

trauma pain management opioid analgesia

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References

National Center for Health Statistics, and Centers for Disease Control and Prevention . Emergency department visits [Data set]. Retrieved from: https://www.cdc.gov/nchs/fastats/emergency-department.htm. 2020.

Karamchandani

Klick

Linskey Dougherty

Bonavia

Allen

Carr

. Pain management in trauma patients affected by the opioid epidemic: A narrative review. J Trauma Acute Care Surg. 2019;87(2):430-439. doi:10.1097/TA.0000000000002292

Sinatra

. Causes and consequences of inadequate management of acute pain. Pain Med. 2010;11(12):1859-1871. doi:10.1111/j.1526-4637.2010.00983.x

Butler

Ancona

Beauchamp

, et al. Emergency department prescription opioids as an initial exposure preceding addiction. Ann Emerg Med. 2016;68(2):202-208. doi:10.1016/j.annemergmed.2015.11.033

Cannon

Bozeman

Miller

, et al. The prevalence and impact of prescription-controlled substance use among injured patients at a Level I trauma center. J Trauma Acute Care Surg. 2014;76(1):172-175. doi:10.1097/TA.0b013e3182ab10de

Kurteva

Habib

Moraga

Tamblyn

. Incidence and variables associated with inconsistencies in opioid prescribing at hospital discharge and its associated adverse drug outcomes. Value Health. 2021;24(2):147-157. doi:10.1016/j.jval.2020.07.015

Imtiaz

Shield

Fischer

, et al. Recent changes in trends of opioid overdose deaths in North America. Subst Abuse Treat Prev Policy. 2020;15(66). doi:10.1186/s13011-020-00308-z

Rui

Santo

Ashman

. Trends in Opioids Prescribed at Discharge from Emergency Departments Among Adults: United States, 2006-2017. Hyattsville, MD: National Center for Health Statistics; 2020. National Health Statistics Reports; no 135.

Chaudhary

Schoenfeld

Harlow

, et al. Incidence and predictors of opioid prescription at discharge after traumatic injury. JAMA Surg. 2017;152(10):930-936. doi:10.1001/jamasurg.2017.1685

10.

Center for Disease Control and Prevention . Drug overdose deaths remain high. Retrieved from: https://www.cdc.gov/drugoverdose/deaths/index.html. 2022.

11.

Dowell

Haegerich

Chou

. CDC guideline for prescribing opioids for chronic pain — United States, 2016. MMWR Recomm Rep (Morb Mortal Wkly Rep). 2016;65(No. RR-1):1-49. doi:10.15585/mmwr.rr6501e1

12.

Centers for Disease Control and Prevention . Annual surveillance report of drug-related risks and outcomes — United States. Surveillance Special Report. Available at: https://www.cdc.gov/drugoverdose/pdf/pubs/2018-cdc-drug-surveillance-report.pdf. 2018

13.

National Center for Health Statistics, and Centers for Disease Control and Prevention . Drug Overdose Deaths in the U.S. Top 100,000. Annually [Data set]. Available at: https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/20211117.htm. 2021.

14.

Center for Disease Control and Prevention . Wide-ranging online data for epidemiologic research (WONDER). Retrieved from: http://wonder.cdc.gov. 2020

15.

Mattson

Tanz

Quinn

Kariisa

Patel

Davis

. Trends and geographic patterns in drug and synthetic opioid overdose deaths — United States, 2013-2019. MMWR Morb Mortal Wkly Rep. 2021;70:202-207.

16.

Hooten

St Sauver

McGree

Jacobson

Warner

. Incidence and risk factors for progression from short-term to episodic or long-term opioid prescribing: A population-based study. Mayo Clin Proc. 2015;90(7):850-856. doi:10.1016/j.mayocp.2015.04.012

17.

American College of Surgeons . Best practice guidelines for acute pain management in trauma patients. Retrieved from: https://www.facs.org/-/media/files/quality-programs/trauma/tqip/acute_pain_guidelines.ashx. 2020.

18.

Shanti

Tan

Shanti

. Adjuvant analgesia for management of chronic pain. Pract Pain Manag. 2006;6(3).

19.

Harvin

Albarado

Truong

VTT

, et al. Multi-modal analgesic strategy for trauma: A pragmatic randomized clinical Trial. J Am Coll Surg. 2021;232(3):241-251.e3. doi:10.1016/j.jamcollsurg.2020.12.014

20.

Hamrick

Beyer

Lee

Cocanour

Duby

. Multimodal analgesia and opioid use in critically Ill trauma patients. J Am Coll Surg. 2019;228(5):769-775.e1. doi:10.1016/j.jamcollsurg.2019.01.020

21.

Joseph’s Health

. ALTO - alternatives to opiates program. 2017. Available at: https://www.stjosephshealth.org/alto. Accessed September 1, 2019.

22.

St. Joseph’s Health . St. Joseph’s ALTO^SM - alternative to opiates. 2017. Available at: https://www.stjosephshealth.org/home-page-articles/item/1908-alto-alternatives-to-opioids. Accessed September 15, 2019.

23.

Drug Enforcement Administration Diversion Control Division . Controlled substance schedules controlled substances alphabetical order. Available at: https://www.deadiversion.usdoj.gov/schedules/orangebook/c_cs_alpha.pdf. Accessed May 15, 2023.

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

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