Newark Beth Israel Medical Center (NBIMC) will partner with the RWJBarnabas Health (RWJBH) Institute for Prevention and Recovery (IFPR) on the SAMHSA FY 2023 Emergency Department Alternatives to Opioids Program (ED-ALT) to implement alternatives to opioids for pain management beginning in the ED. NBIMC primarily serves the eastern and southeastern portions of Essex County, New Jersey, which is composed of urban communities and suburban towns. Essex County has a larger proportion of Black and Hispanic or Latino residents than New Jersey as a whole-35.9% of the population is non-Hispanic Black and 24.3% of the population is Hispanic or Latino, compared to 12.3% and 21.5% statewide, respectively. New Jersey has struggled with the opioid overdose crisis in the past decade, with a 133.8% increase in drug overdose deaths from 2013 to 2021. Essex County has been particularly affected, with a 208.3% increase in the same timeframe. In 2021, Essex County had 408 suspected overdose deaths, the most of any county in the state. In the same year, providers in the county wrote 243,920 opioid prescriptions, and law enforcement and emergency medical services administered naloxone 2,084 times, a fourfold increase from 2015. In 2021, Essex County had the most residents admitted for treatment for opioid use in the state, with 4,258 admissions. Some of the most common diagnoses among patients who received opioid prescriptions in the NBIMC ED in 2022 included extremity pain (14.9%), sickle cell crisis (11.2%), chest pain (4.0%), and pelvic and perineal pain (1.5%). The goals of the ED-ALT program are to: 1) expand and utilize evidence-based approaches to treat painful conditions frequently diagnosed in the NBIMC ED, 2) institute a comprehensive education and training program to disseminate information and educate clinical staff and patients on the protocols and best practices related to the use of opioid prescriptions, alternatives to opioids, and medications for opioid use disorder, and 3) identify, grow, and utilize consultation and referral networks and protocols for primary care, specialty pain management, and ED- and hospital-based treatment, communication, and collaboration. The project will utilize three evidence-based practices-Enhanced Recovery After Surgery, Transitional Pain Service, and social prescribing-to effectively treat pain, decrease opioid use, and support self-management of persistent pain. The project proposes to serve 500 unduplicated individuals annually and 1,500 unduplicated individuals over the entire project period with grant funds. The project will measure progress towards goals and objectives by utilizing RWJBH's electronic health record, the Brief Pain Inventory-Short Form, and the Pain Catastrophizing Scale.