ALTO program fails to lower opioid prescribing in trauma patients

15 Aug 2024
Opioids, despite their initial efficacy as painkillers, can make pain worse.Opioids, despite their initial efficacy as painkillers, can make pain worse.

Implementation of a hospital-wide Alternatives to Opiates (ALTO) program falls short of reducing in-hospital or discharge opioid prescribing, reports a study.

This single-centre, retrospective study included adult patients admitted for >24 hours with the primary diagnosis of traumatic injury between August 2018 and October 2019. Those with alcohol or polysubstance abuse, chronic opioid use, or in-hospital mortality were excluded.

The incidence of opioid prescribing at hospital discharge pre- and post-ALTO was the primary outcome. Secondary outcomes included the proportion of patients with in-hospital opioid, nonopioid and multimodal analgesia, and hospital and ICU length of stay (LOS).

Seven hundred three patients (mean age 59 years, 58.7 percent male) met the eligibility criteria: 471 in pre-ALTO and 232 in post-ALTO groups. The mean initial Injury Severity Score (ISS) was 9.1. The post-ALTO group showed a slightly higher prevalence of opioid prescribing at hospital discharge than the pre-ALTO group (43.8 percent vs 39.4 percent; p=0.1237).

Most patients received prescriptions of in-hospital opioid (87.5 percent vs 70.4 percent; p<0.0001) and nonopioid (98.7 percent vs 93.6 percent; p=0.0027) analgesics or multimodal analgesia (87.5 percent vs 84.3 percent; p=0.2591).

Additionally, median hospital (4 vs 5; p=0.3427) and ICU (3 vs 2; p=0.3461) LOS were similar between pre- and post-ALTO groups

“Opioids remain mainstay for trauma-related pain treatment,” the researchers said. “ALTO was not associated with less in-hospital or discharge opioid prescribing.”

J Pharm Pract 2024;doi:10.1177/08971900231189353