Emergency Department Alternatives to Opioids Program (ED-ALT)
The Emergency Department Alternatives to Opioids Program (ED-ALT) is a SAMHSA funded service program aimed to reduce the likelihood of future opioid misuse by developing and implementing alternatives to the use of opioids for pain management in hospitals and emergency department (ED) settings.
The program also supports identification of and intervention for opioid use disorder (OUD) among individuals presenting in hospitals and ED settings with pain conditions.
FY2023 is the second cohort with 15 grants awarded. The first cohort of 10 grantees were awarded in 2020. Two additional grants were funded in early 2021.
Some of the activities stated in the FY 2023 Notice of Funding Opportunity (NOFO), for the use of SAMHSA funds are listed below.
- Develop and implement person-centered treatment approaches for painful conditions frequently treated in the recipient’s organizational setting.
- Encourage providers to pursue training on MOUD and how to incorporate MOUD during treatment.
- Train providers and other hospital personnel on protocols or best practices related to the use of opioid prescriptions and alternatives to opioids for pain management in the ED, taking into consideration different cultural explanations and approaches to pain and potential provider biases.
- Develop or continue strategies to provide alternatives to opioids.
- Seek consultation with physicians, and other relevant ED staff who have implemented evidence-based and best practices to alternatives to opioids for pain management, especially across different racial, ethnic, and cultural groups.
- Disseminate evidence-based practices to implement alternatives to opioids for pain.
- Utilize SAMHSA’s existing Technical Assistance activities including the Technology Transfer Centers (ATT); the Opioid Response Network (ORN); and the Providers’ Clinical Support System (PCSS) TA Centers to educate and train staff.
- Increase, improve, strengthen, and evaluate partnerships with community-based organizations, faith-based organizations, government agencies (including public health departments), businesses, educational institutions, and other organizations to meet patient’s needs.
Additional information from the FY 2023 NOFO is available.
ED-ALT Outcomes
The ED ALT grantee programs include a mixture of evidenced-based non-opioid pharmacological and non-pharmacological alternative therapies. Below are the top conditions being treated and the therapies being used for treatment as of 2022.
| Most Common Pain Conditions | Most Common Non-Opioid Pharmacological Therapies (Electronic Health Record - Order panels) | Most Common Alternative (ALTO) Therapies |
| Abdominal Pain | Acetaminophen | Acupuncture |
| Back Pain | Diazepam | Dry Needling |
| Dental Pain | Lidocaine | Physical Therapy |
| Headaches | Muscle-Relaxants | Nerve Block |
| Musculoskeletal Pain | Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) | Transcutaneous Electrical Nerve Stimulation (TENS) |
| ED ALT Grant Program Measure | FY 2021 Output metric/ Planned goal |
| Number of providers trained on non-opioids therapies. (Output) | FY 2021: 2,468 Planned Goal: 1,020 (Goal Exceeded) |
| Number of patients who received non-opioid therapies. (Output) | FY 2021: 113,563 Planned Goal: 8,364 (Goal Exceeded) |
SAMHSA funds the Providers’ Clinical Support System – Medications for Opioid Use Disorder (PCSS-MOUD) to provide free practitioner training in the evidence-based prevention and treatment of OUD and offers the trainings needed to apply for DEA registrations to prescribe Schedule II-V medications.
SAMHSA Point of Contact: greg.grass@samhsa.hhs.gov.