Duncan RW, et al. - The benefit of implementation of an alternative to opioids (ALTO)-first approach to pain management on opioid use in an Emergency Department as well as its impact on patient satisfaction scores was determined. Data collected before and after the implementation of the intervention was analyzed. Opioid reduction was measured in morphine equivalents (ME) administered per visit, and the Press Ganey survey was used to gather secondary outcomes on patient satisfaction. The use of intravenous (IV) opioids in the Emergency Department was seen to be significantly reduced as a consequence of implementation of an ALTO-first, multimodal treatment approach to pain management. However, no changes were seen in patient satisfaction scores following implementation.