Gianluca Cerri, MD, an emergency medicine physician with more than two decades of experience in rural Louisiana, is urging fellow rural physicians and hospitals to adopt a personal 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 the ED, not after a callback that may never happen. Cerri is publishing the recommendation so departments can consider adopting it as a matter of course rather than an exception.
Cerri’s proposal stems from the reality that rural EDs often serve as the only point of contact a patient with opioid use disorder will have with the health system for weeks. He 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. “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 the discharge paperwork.
Under this standard, three things would happen differently in a typical opioid-related visit. First, the screening question gets asked directly, not folded into a broader social history where it can be skipped under time pressure. Second, the MAT conversation happens with the treating physician in the room, not deferred to a social worker who may not be on shift. Third, discharge paperwork names 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.”
The implications of Cerri’s recommendation extend beyond individual practice. If adopted widely, it could reshape how rural emergency departments approach opioid use disorder, turning the ED from a mere triage point into a site of active treatment initiation. For patients, this could mean faster access to life-saving medication and a clearer path to recovery, potentially reducing overdose deaths and improving long-term outcomes. For physicians, it represents a shift in mindset—one that integrates addiction medicine into everyday emergency care without requiring additional resources. As rural health systems continue to struggle with staffing shortages and limited specialty care, Cerri’s policy offers a pragmatic, low-cost strategy that leverages the existing patient encounter. While not a mandate, the recommendation challenges other physicians to reconsider what constitutes complete care for a patient with opioid use disorder. The measure of success, as Cerri frames it, is not the number of acceptances but the consistency of offering a real choice.
