Subcutaneous Opioids: Under the Skin Irritation or New Standard of Care?

Abstract

Opioids are widely used for pain management in hospitalized adults and can be administered through various routes. While oral (PO) and intravenous (IV) routes remain most common, the subcutaneous (SUB-Q) route is underutilized despite historical safety and supporting literature. This quality improvement study implemented a revised standard of practice (SOP) for opioid administration, promoting the PO route when feasible and SUB-Q as the preferred parenteral route. IV remained available when clinically appropriate. This pilot study was conducted on a 24-bed adult general medicine unit at a large community teaching hospital. Extensive interdisciplinary education was provided prior to SOP implementation. Primary outcomes evaluated IV and SUB-Q opioid administrations. Secondary outcomes analyzed total opioid administrations (all routes), mean oral morphine equivalents (OMEs), and mean patient-reported pain scores (0-10 scale). All outcomes were measured per patient day (PPD) during the first five days of admission. IV opioid administration decreased by 33% while overall opioid consumption (OMEs) was modestly reduced. Statistically significant reductions in average pain scores were observed postintervention on days one and five. Implementation of a new opioid SOP was associated with reduced IV opioid use while maintaining effective pain control across both groups.