Gianluca Cerri, MD, an emergency medicine physician with over twenty years of practice, much of it in rural Louisiana, is recommending that rural physicians and hospitals adopt a standing policy: when a patient in the emergency department screens positive for opioid use disorder, the conversation about medication-assisted treatment (MAT) should occur before that patient leaves, not after a callback that may never come. Cerri, who is board certified in both emergency medicine and addiction medicine, published the recommendation as a personal standard for other departments to consider, not as a hospital mandate.
The rationale rests on the realities of rural care. Rural emergency departments often serve as the only point of contact a patient with opioid use disorder will have with the health system for weeks. Cerri has said that a discharge instruction to "follow up with addiction services" is close to useless if the nearest addiction clinic is ninety minutes away and has a six-week waitlist. In that context, deferring the conversation to a later appointment or a social worker who may not be on shift can mean the conversation never happens. "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 standard Cerri proposes, 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, rather than being deferred to a social worker who may not be on shift. And discharge paperwork would name a specific next contact, whether that is a warm handoff, a prescription bridge, or a specific clinic name and phone number, instead of a general instruction to seek follow-up care. None of this requires new staff or new equipment, Cerri said; 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 the 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." 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 the recommendation because he wants other physicians and hospital leaders to weigh it on its own terms. 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," 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 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 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."
For HR vendors, this recommendation signals a growing emphasis on integrating behavioral health and addiction treatment into frontline care. Telehealth platforms, clinical decision support tools, and training programs that enable emergency physicians to initiate MAT could see increased demand. Additionally, as more physicians pursue dual board certifications, credentialing and continuing education vendors may need to adapt their offerings to support this integrated approach. The shift toward immediate intervention also highlights the need for better care coordination tools that facilitate warm handoffs and follow-up scheduling, particularly in rural settings where resources are scarce. Vendors that can help bridge these gaps—through remote consultation, e-prescribing, or patient engagement solutions—may find new opportunities as hospitals look to implement similar standards.
