The CDC recommends patients with pain should receive treatment that provides the greatest benefit. As such, opioids are not generally the first-line therapy for acute or chronic pain. Many hospitals and health systems are beginning to implement Alternatives to Opioids (ALTO) programs in order to expand more clinically effective treatments for pain.  Key Takeaways for the ED 

  1. When preparing to implement nonopioid pain management into the ED, leadership should consider physician and nursing education/training on alternatives to opioids to empower staff to use an alternative.  
  2. It takes time to learn about and become comfortable with new therapies and medication regimens. Physician champions, particularly those experienced or committed to non-opioid alternatives, can speak with fellow ED physicians prior to implementing these changes.  
  3. Some of these nonopioid alternatives are administered in the ED but are not available for a prescription for patients to take home. EDs should consider alternatives available to prescribe to patients upon discharge.  
  4. EDs can work with their IT department to add these order sets for these alternatives to EMR quick lists for clinician ease to prescribe.  
  5. Modify order sets within the hospital’s electronic medical record to promote non-opioid therapies. For example, if the order set automatically has an opioid selected, change the order set so the clinician has to manually check an opioid.  

Resources to Get You Started 

CDC: Nonopioid Treatments for Chronic Pain

Colorado ACEP 2017 Opioid Prescribing & Treatment Guidelines: Confronting the Opioid Epidemic in Colorado’s Emergency Departments

Colorado ALTO Project – Patient Pathways

Colorado Hospital Association ALTO Procedural Videos, demonstrating how to administer non-opioid therapies in the ED.   Return to Table of Contents