Reducing intravenous opioid reliance with subcutaneous administration in the emergency department

Dear Editor, Intravenous (IV) opioid administration has been the standard in emergency departments (EDs) for rapid pain management, with studies showing that IV opioids are used in over 70% of ED encounters involving moderate to severe pain.1 This route is often preferred for its rapid onset and perceived efficacy. However, IV opioid use is associated with higher rates of adverse events, including respiratory depression and hypotension, and risk of opioid use disorder.1 Subcutaneous (SQ) opioid administration represents a viable alternative for patients, offering comparable analgesic efficacy with safer hemodynamics, yet remains underutilized in acute care settings. Transitioning from IV to SQ opioid use aligns with broader opioid stewardship efforts, which aim to minimize unnecessary opioid exposure and associated harms.2,3 SQ administration may reduce adverse events and streamline workflows by eliminating the need for IV access. Our global aim was to reduce the use of IV opioids in the ED by promoting SQ opioid administration, where clinically appropriate, such as for pain management.4 We also monitored associated antiemetic rates while supporting a shift toward more patient-centered practices.