Gianluca Cerri, MD, an emergency medicine physician with more than two decades of experience in rural Louisiana, is urging his colleagues to adopt a simple but potentially life-saving practice: when a patient in the emergency department screens positive for opioid use disorder, the conversation about medication-assisted treatment (MAT) should occur during the same shift, before the patient leaves the hospital. Cerri, who is board certified in both emergency medicine and addiction medicine, has made this recommendation public in hopes that other rural physicians and hospitals will consider implementing it as a standard of care.
The rationale is rooted in the realities of rural health care. Emergency departments often serve as the only point of contact for patients with opioid use disorder, who may not have access to specialized addiction services for weeks or even months. Cerri points out that a discharge instruction to "follow up with addiction services" is nearly meaningless when the nearest clinic is ninety minutes away and has a six-week waiting list. "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 Cerri's proposed policy, three key changes would occur in a typical opioid-related visit. First, the screening question would be asked directly, rather than being buried in a broader social history that can be skipped when time is tight. Second, the MAT conversation would take place 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—whether a warm handoff, a prescription bridge, or a clinic name and phone number—instead of a vague instruction to seek follow-up care. None of this requires new staff or equipment; it simply requires physicians to treat the conversation as part of the medical workup.
Cerri's dual training informs his approach. His addiction medicine board certification, 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. "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." By understanding induction protocols and withdrawal management, emergency physicians can initiate treatment in the ED itself when appropriate, rather than treating the visit as a mere triage point.
Cerri emphasizes that he is not mandating this policy for any department. "I'm not telling any one department how to run itself," he 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 describes the policy as a floor, not a ceiling, and acknowledges that not every patient will accept MAT on the first conversation. "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."
For readers and the health care industry, this recommendation highlights a critical gap in rural addiction care and offers a low-cost, high-impact solution. If adopted, it could increase access to MAT, reduce overdose risks, and improve continuity of care for a vulnerable population. As the opioid crisis continues to strain emergency departments, Cerri's call to action may inspire other physicians to integrate addiction medicine into their daily practice, ultimately saving lives.
