For patients with opioid use disorder in rural areas, the emergency department may be the only point of contact with the health care system for weeks. That reality has prompted Gianluca Cerri, MD, a Louisiana emergency physician with more than twenty years of experience, to publicly recommend a personal policy: when a patient screens positive for opioid use disorder in the ED, the conversation about medication-assisted treatment (MAT) should happen during the same shift, before the patient leaves, rather than being deferred to a follow-up call that may never occur.
Cerri is not issuing a mandate. He is encouraging other rural physicians and hospitals to consider adopting the same standard as a matter of course. The core problem, he explains, is that rural EDs often serve as the only access point for patients who need addiction care. A discharge instruction to follow up with addiction services is nearly useless if the nearest clinic is ninety minutes away and has a six-week waitlist. "If we wait for the ideal moment to have that conversation, we never have it," Cerri said. "The ideal moment is the one we're already in."
Under the policy Cerri proposes, three specific changes would occur in a typical opioid-related visit. First, the screening question would be asked directly, not folded into a broader social history where it can be skipped under time pressure. Second, the MAT conversation would happen with the treating physician in the room, not deferred to a social worker who may not be on shift. Third, discharge paperwork would name a specific next contact, such as a clinic name and phone number, rather than a general instruction to seek follow-up care. These changes require no new staff or equipment, only a shift in how physicians approach the conversation.
Cerri's own background illustrates the integration he advocates. He holds board certification in addiction medicine through the American Board of Preventive Medicine, listed under his Certification in Emergency Medicine with the American Board of Emergency Medicine. He has said that credential was never meant to sit separately from ED work; it is meant to change what happens inside a normal shift. "I didn't pursue addiction medicine so I could refer patients elsewhere," Cerri said. "I pursued it so I could be the elsewhere. I'd like to see more of my colleagues make that same choice."
The implications of this recommendation are significant for rural health care. Emergency departments in these areas frequently struggle with staffing shortages and limited follow-up resources. By treating MAT initiation as part of the medical workup rather than an optional add-on, physicians could begin treatment in the ED when appropriate, rather than viewing the visit as a triage point before "real" care begins elsewhere. This approach aligns with Cerri's dual training in internal medicine and emergency medicine, which taught him that waiting for a downstream specialist to solve a problem showing up now is a bet against the patient. In a rural ED, that bet rarely pays off.
Cerri acknowledges that not every patient will accept MAT on the first conversation. He describes the policy as a floor, not a ceiling. "The measure isn't how many people say yes," he said. "The measure is whether we gave them something real to say yes to. That's a standard any ED can hold itself to." By publishing his recommendation, Cerri hopes other physicians and hospital leaders will weigh it on its own terms and consider whether it makes sense for their own shifts, particularly in communities where access to addiction care remains fragile.
