INTRODUCTION: Opioid misuse and dependence remain critical public health issues in the U.S., contributing significantly to reduced life expectancy. Emergency departments (EDs) are key settings for implementing opioid reduction strategies when treating acute pain, such as nonpharmacologic treatment options like acupuncture. This study explored clinician-related factors influencing the integration of the Pain Elimination through Acupuncture Research and Learning (PEARL) program for pain reduction within a high-volume urban ED. METHODS: This study employed a sequential mixed methods design, involving surveys and interviews with ED clinicians. An 11-item electronic survey was administered annually to assess clinician attitudes related to appropriateness and effectiveness of integrating acupuncture into the ED's comprehensive care plan for treatment of pain. Near the end of the 3rd year of the PEARL program, semi-structured interviews were conducted to gather in-depth insights into clinician knowledge and perceptions of the program. RESULTS: Quantitative survey data from 99 eligible ED clinicians indicated positive perceptions of the program's appropriateness and effectiveness, and improved understanding of acupuncture referral procedures. Analysis of qualitative interviews conducted with 16 ED clinicians revealed five key themes: acupuncture as an acceptable analgesic strategy to reduce the use of opioids, patient benefits, program presence in the ED, integration challenges, and the need for continued education. CONCLUSION: Strong acceptance of acupuncture as a feasible nonpharmacologic addition to the comprehensive pain care plan used in the ED was observed. Dedicated space, expanded acupuncture staff and hours, and ongoing training of ED staff will require institutional support to sustain acupuncture as a nonpharmacologic treatment option for ED patients.