Alternatives to Opioids for Pain Management in the ED

The Alternatives to Opioids Program (ALTO SM) is a comprehensive plan for the management of acute and chronic pain as well as opioid addiction and abuse in the emergency department. The program aims to utilize evidence based multi-modal non-opioid approaches for the pain associated with headache, lumbar radiculopathy, musculoskeletal pain, renal colic, and fracture/dislocation. In addition, patients that present with opioid overdose or abuse and misuse of opioids are partnered with a peer counselor to offer direct admission for opioid addiction recovery. The ALTO SM program has partnered with St. Joseph's Healthcare System Opioid Overdose Prevention and Naloxone Distribution Program to educate friends and family members of high risk individuals about prescription opioid abuse and provide a Naloxone kit to be kept in the home. Additionally, the principles of the ALTOSM program have been adopted by the St. Joseph’s Departments of Family Medicine, Pain Management, PM&R, and Psychiatry. Our multidisciplinary team works to cater treatment plans for all patients. The ALTOSM Program works closely with mental health facilities and detox centers such as Eva’s Village and the Straight and Narrow Program, both located in Paterson. Peer screeners evaluate opioid addicted patients in the emergency department in an effort to enroll them into a detox program immediately following ED discharge. 

Opioids are an important part of pain management but with the ALTO program they are reserved for severe pain, end of life pain, and surgical conditions. There is a strong focus on patient safety and education. Patients are educated on the importance of using alternatives as a first line for mild to moderate pain, reserving opioids are rescue medication or second line treatment. 

Urgent Matters ALTO Presentation Slides

ALTO Protocol


Publication Date: 
Toolkit PDF: 
St. Joseph's Regional Medical Center
Toolkit Category: 
Clinician Initial Evaluation
Disposition Decision
Exit from ED
Clinical Areas Affected: 
Emergency Department
Fast Track
Geriatric Emergency Department
Nursing Home
Outpatient Units
Psychiatric Consult Departments