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. When that visit ends with a generic instruction to follow up with addiction services, the result can be a missed opportunity that never comes around again. Gianluca Cerri, MD, an emergency physician with more than twenty years of experience in rural Louisiana, is proposing a simple but potentially transformative standard: every patient who screens positive for opioid use disorder should have a conversation about medication-assisted treatment before leaving the ED, not after a callback that may never happen.
Cerri is not issuing a mandate. He is publishing the policy as a personal commitment and encouraging other rural physicians and hospital leaders to weigh it against their own practice. The rationale is rooted in the realities of rural care. The nearest addiction clinic may be ninety minutes away and have a six-week waitlist. In that context, a discharge instruction to seek follow-up is close to useless. As Cerri put it, "If we wait for the ideal moment to have that conversation, we never have it. The ideal moment is the one we're already in."
The policy sets a low but concrete 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. That could mean a warm handoff, a prescription bridge, or a specific clinic name and phone number written on discharge paperwork. Under this standard, three things change in a typical opioid-related visit. The screening question is asked directly, not buried in a broader social history where it can be skipped under time pressure. The MAT conversation happens with the treating physician in the room, not deferred to a social worker who may not be on shift. And discharge paperwork names a specific next contact rather than a vague instruction to seek follow-up care. None of this requires new staff or equipment, only a shift in how physicians treat the conversation.
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 that credential was never meant to sit separately from ED work. It is meant to change what happens inside a normal ED shift. "I didn't pursue addiction medicine so I could refer patients elsewhere," he 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 appropriate, rather than treating the visit as a triage point before real care begins somewhere else.
Cerri is making the case publicly because he wants other physicians and hospital leaders to consider it on its own terms, not because any department is required to adopt it. He points 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 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. He describes 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. "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."
For rural hospitals and emergency physicians, the implications are significant. Adopting a same-shift conversation standard could reduce the treatment gap for opioid use disorder, improve patient outcomes, and make better use of the limited touchpoints that rural patients have with the health care system. It also signals a broader shift in emergency medicine: integrating addiction treatment into the ED rather than treating it as a separate specialty. As Cerri's example shows, the change may not require new resources, but it does require a willingness to act in the moment.
