The Rocky Mountain Chapter of the Society of Hospital Medicine developed 2020 Opioid Prescribing and Treatment Guidelines for the medical inpatient, including five pathways for treating medical inpatients with pain. Ten Colorado hospitals participated in a 6-month initiative to implement the prescribing pathways, with an aim of reducing opioid prescribing by 15 percent for five commonly encountered medical conditions. Results showed 9.4 percent decrease in opioid morphine equivalent units, 3.4 percent reduction in opioid administrations, and 5.1 percent increase in alternatives to opioid administrations per patient day. Specialty-specific opioid prescribing guidance can help hospitalists change opioid prescribing behavior and should be considered in other specialties.