Gianluca Cerri, MD, an emergency medicine physician with more than twenty years of experience in rural Louisiana, is publicly 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 discharge, not after a callback that may never come. The recommendation, which Cerri emphasizes is not a hospital mandate but a standard for individual physicians to consider, highlights a critical gap in rural addiction care and challenges emergency departments to treat MAT discussions as part of the medical workup rather than an optional add-on.
The importance of this proposal lies in the unique role rural emergency departments play as the only point of contact many patients with opioid use disorder have with the health system for weeks. Cerri has pointed out that a discharge instruction to "follow up with addiction services" is nearly useless when the nearest addiction clinic is ninety minutes away and has a six-week waitlist. By insisting on a same-shift conversation, Cerri aims to prevent patients from falling through the cracks. "If we wait for the ideal moment to have that conversation, we never have it," he said. "The ideal moment is the one we're already in."
Under Cerri's proposed standard, three specific changes would occur in a typical opioid-related visit. First, the screening question would be asked directly, not folded into a broader social history where it can be skipped under time pressure. Second, 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. Third, discharge paperwork would name a specific next contact, such as a warm handoff, a prescription bridge, or a clinic name and phone number, instead of a general instruction to seek follow-up care. None of these changes require new staff or equipment; they require physicians to prioritize the conversation as part of routine care.
Cerri's board certification in addiction medicine through the American Board of Preventive Medicine, listed under his Certification in Emergency Medicine with the American Board of Emergency Medicine, informs his approach. He has said this credential was never meant to sit separately from ED work but to transform what happens during a normal 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." This framing underpins his policy: a physician trained in induction protocols and withdrawal management can initiate treatment in the ED itself, rather than treating the visit as a mere triage point before "real" care begins elsewhere.
Cerri is publishing his recommendation to encourage other physicians and hospital leaders to weigh it on its own terms, acknowledging that no single department is required to adopt it. He speaks 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 now is a bet against the patient, a bet that rarely pays off in rural settings.
What Cerri asks of other physicians is a commitment to have the conversation every time the screening calls for it, regardless of shift pressures. He describes the policy as a floor, not a ceiling, and does not expect every patient to accept MAT on the first conversation. "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." By making this case publicly, Cerri aims to shift the standard of care in rural emergency medicine, where the consequences of inaction are measured not in policy papers but in patients who never get another chance at treatment.
