Colorado Opioid Safety Pilot

Implementation of prescribing and treatment guidelines to reduce opioid use in emergency departments

In 2016, the Colorado Hospital Association (CHA) launched the CHA Colorado Opioid Safety Survey to better understand the opioid work being done by member hospitals and health systems across the state.

Nearly 80% of all survey respondents indicated they were actively working on opioid safety. The emergency department (ED) was identified as the number one area in which opioid safety was a concern. More than 90% of participants wanted more information on how CHA could assist with opioid safety.

Following the survey, CHA created an Opioid Safety Steering Committee, with the goal of identifying how CHA could bring value to its hospital partners and help combat Colorado's opioid crisis. CHA developed partnerships with several organizations and formed the Colorado Opioid Safety Collaborative to improve opioid safety in Colorado EDs.

The Colorado Opioid Safety Collaborative’s primary objective was to implement the Colorado American College of Emergency Physician (ACEP) 2017 Opioid Prescribing & Treatment Guidelines in select EDs across Colorado. The pilot focused specifically on implementation of the alternative to opioid (ALTO) approach detailed in the Colorado ACEP guidelines. The collaborative anticipated that changing pain management strategies would result in the reduction of opioid use and an increase of ALTO use, without a reduction in patient satisfaction scores.

35,000 fewer opioid administrations during the 2017 pilot versus the 2016 baseline period...decrease in opioid usage by 36%.

Continuum of Care
Type of Evidence
Report with evaluation
Response Approach
Cautious Opioid Prescribing
Peer-reviewed Article

Evidence of Program Effectiveness

According to a report with an evaluation: “All 10 EDs successfully completed the opioid reduction pilot. Over the course of the six-month intervention period, the 10 EDs saw a total of 130,631 unique patient visits. This volume was comparable to the same time in the prior year (n=131,765). In aggregate, the EDs decreased opioid usage (morphine equivalent units per 1,000 ED visits) by 36 percent between 2017 and the comparable six-month period in 2016, far exceeding the project goal of 15 percent. This amounted to 35,000 fewer opioid administrations during the 2017 pilot versus the 2016 baseline period, adjusted for number of visits.”

According to a peer-reviewed paper: "In aggregate, the EDs decreased opioid usage, measured in morphine equivalent units per 1000 ED visits, by 37.4% after the intervention. Statistically significant decreases were seen in every type of opioid. Statistically significant increases in ALTO usage were also noted across all study hospitals. There were no significant changes observed in Hospital Consumer Assessment of Healthcare Providers and Systems patient satisfaction scores before and after the intervention in the hospitals with Hospital Consumer Assessment of Healthcare Providers and Systems data, and there was a small but statistically significant improvement in pain scores...This study demonstrated the feasibility and effectiveness of implementing ALTO protocols to reduce opioid use in the ED setting without an overall reduction in patient perception of pain or satisfaction with care." (Stader et al., 2020)