St. Joseph's Regional Medical Center's Alternatives to Opiates Program (ALTO)

Rationale / Objectives

St. Joseph's Regional Medical Center was concerned over the rate of overprescription of opiates and opiate-related deaths. 75% of patients who sought emergency treatment did so because of pain.1 The emergency department at St. Joseph's Regional Medical Center worked to promote the safety of its patients by developing the Alternatives to Opiates Program. 

Project/Program Description & Major Achievements

The Alternatives to Opiates program aimed to use only non-opioid treatments in the management of pain, primarily targeting five common conditions: renal colic, sciatica, headaches, musculoskeletal pain, and extremity fractures. Where they would have been prescribed opiates before, patients were given targeted non-opioid medications, trigger point injections, nitrous oxide, and ultrasound-guided nerve blocks.1 In the first five months, the hospital reduced its total opioid use by 38%.

Lessons Learned

The Alternatives to Opiates Program allowed for physicians to expand the options available to them and resulted in heightened patient satisfaction.1

For more information: Opioid Crisis Management: Foundation Roadmap

People / Organizations Involved

Further Description

St. Joseph’s employees over 6,000 people and operates a full continuum of care, including a university tertiary care medical center, a state-designated children’s hospital, an acute care medical center, rehabilitation and long-term care facilities, and comprehensive home care. The Emergency Department at St. Joseph's expected approximately 170,000 patients in 2016. As mentioned previously, exposure to opiates was high in emergency visits due to pain. Medical leadership was determined to move away from endangering their many vulnerable patients.

The program began with an initial 300 patients being first treated with alternative protocols and grew from there.2

Major Achievements

The total decline in opioid use was 38% at St. Joseph's Medical Center with an estimated 75% success rate among those patients involved. However, in approximately 25% of cases, patients later required opioids to manage their pain. Most of these patients suffered from sciatica, kidney stones, or intense migraines.1 The program is still relatively new and has a local scope, however, as the program develops it is likely to expand to other acute care settings.1

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