Better opioid responsibility: implementing novel guidance as an opioid standard of care in academic and rural settings

Intravenous opioids have a faster onset and greater euphoric potential than oral or subcutaneous routes, 1 2 with observational studies linking inpatient intravenous exposure to higher odds of subsequent opioid-related harms—meanwhile, an urban academic opioid standard prioritized oral/subcutaneous administration and reduced intravenous exposure by 84% without compromised pain control.3 Considering that rural hospitals face unique challenges in opioid stewardship,4 we implemented this opioid standard in two rural hospitals, hypothesizing that favoring oral and subcutaneous opioids over intravenous would reduce parenteral opioid use without increasing pain scores.