For patients with opioid use disorder in rural areas, the emergency department is often the only point of contact with the health care system for weeks at a time. That reality has prompted Gianluca Cerri, MD, an emergency physician with more than twenty years of experience, much of it in rural Louisiana, to recommend a standing policy for rural physicians and hospitals: when a patient screens positive for opioid use disorder in the ED, the conversation about medication-assisted treatment should occur before discharge, not after a callback that may never come.
Cerri emphasizes that this is not a hospital mandate but a standard he believes other physicians should consider adopting as a matter of course. The rationale is practical. A discharge instruction to “follow up with addiction services” is nearly useless if the nearest addiction 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.”
He proposes a low bar for what counts as sufficient: a direct conversation in plain language about what MAT is, what buprenorphine induction can look like, and what the next real step is—whether that’s a warm handoff, a prescription bridge, or a specific clinic name and phone number written on discharge paperwork. Under this standard, three things would change in a typical opioid-related visit. The screening question would be asked directly, not folded into a broader social history where it can be skipped under time pressure. The MAT conversation would happen with the treating physician in the room, not deferred to a social worker who may not be on shift. Discharge paperwork would name a specific next contact, rather than a general instruction to seek follow-up care.
None of this requires new staff or new equipment. It requires physicians to treat the conversation as part of the medical workup, not as an optional add-on if time allows. Cerri’s board certification in addiction medicine, through the American Board of Preventive Medicine, is listed under his Certification in Emergency Medicine with the American Board of Emergency Medicine. He has said this credential was never meant to sit separately from ED work. It is meant to change what happens inside a normal ED shift, and he believes more emergency physicians should pursue that same training.
“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.” That framing is the basis for the policy he is proposing. A physician who understands induction protocols and withdrawal management can start treatment in the ED itself, in cases where that is appropriate, rather than treating the ED visit as a triage point before real care begins somewhere else.
Cerri has said he is publishing this recommendation because he wants other physicians and hospital leaders to weigh it on its own terms, not because any single department is required to adopt it. He is speaking to the same rural staffing and follow-up gaps he sees in his own work. “I’m not telling any one department how to run itself,” Cerri said. “I’m telling colleagues what I’ve decided to hold myself to, and asking them to consider whether it makes sense for their own shifts too.”
He has pointed to the same reasoning that shaped his dual training in internal medicine and emergency medicine: waiting for a downstream specialist to solve a problem that shows up in front of you now is a bet against the patient. In a rural ED, that bet rarely pays off for the patient who cannot easily get back into the system. Cerri has described the policy as a floor, not a ceiling. He does not expect every patient to accept MAT on the first conversation. He is asking other physicians to commit to having the conversation every time the screening calls for it, regardless of how the shift is running or how many patients are waiting. “The measure isn’t how many people say yes,” Cerri said. “The measure is whether we gave them something real to say yes to. That’s a standard any ED can hold itself to.”
