The Emergency Department as a Lifeline: Why MAT Should Begin at First Contact

The Moment That Changed My Perspective

There was a moment, not too long ago, that sticks with me. A young man came into the emergency department—disheveled, anxious, sweating. He was in withdrawal. He had overdosed the week before, and this time, he said he wanted help. He wasn’t combative or angry. He was just tired—of the cycle, of the pain, of the stigma. For a long time, emergency medicine has been about stabilizing patients and moving them to the next level of care. But what do we do when there is no clear next step? When addiction treatment is hours away, or nonexistent, especially in rural areas?

That patient, and many others like him, made me rethink the role of the emergency department. It’s not just a place for physical trauma. It’s where people show up when they have nowhere else to go. And that makes it the perfect place to start something meaningful—like Medication-Assisted Treatment (MAT).

MAT in the ED Isn’t Radical—It’s Rational

For a long time, the idea of starting MAT in the emergency department was met with hesitation. Some providers weren’t familiar with it. Others worried it would be too time-consuming, or that follow-up care wouldn’t be available. But we wouldn’t withhold treatment from a patient having a heart attack because we weren’t sure they’d get follow-up with a cardiologist. We treat the emergency in front of us—and opioid use disorder is no different.

Buprenorphine, one of the most common medications used in MAT, can be administered safely in the ED. In many cases, it calms withdrawal symptoms quickly and allows patients to think clearly—sometimes for the first time in days or weeks. That clarity is the window we need to help them see another way forward.

I’ve seen patients go from barely functional to calm and coherent within hours. I’ve had conversations with them, real conversations, about what brought them to this point and what they want for their lives. These are moments we can’t afford to miss.

Rural Communities Deserve Better Access

In rural areas, resources are often limited. That’s a reality I live every day. There are fewer mental health providers, fewer clinics specializing in addiction treatment, and very little public transportation. For patients struggling with opioid use disorder, all of that creates an enormous barrier to care.

That’s why the emergency department becomes even more important in rural communities. It’s often the only point of contact with the healthcare system. If we miss that opportunity—if we send someone home with just a list of phone numbers and no real support—we’re not helping them. We’re pushing them back into a dangerous cycle.

When I treat a patient with opioid use disorder, I don’t see someone who’s given up. I see someone who made a decision to come through our doors. That decision takes courage. We need to meet it with compassion, not bureaucracy.

The Power of a First Step

Addiction isn’t solved in a single visit. That’s something we all understand. But the first step—taking the edge off withdrawal, showing a patient that treatment is possible, connecting them to a path forward—that’s within our power. And often, that’s the most critical step.

I’ve had patients return weeks or months after their initial visit and tell me that starting MAT in the ED was the turning point. It didn’t fix everything, but it gave them a foundation. It showed them that someone cared enough to treat their condition like the real medical issue it is. That’s powerful. And it’s something we can replicate every day.

Combating Stigma, One Patient at a Time

There’s still too much stigma around addiction—among the public, in healthcare, and even within ourselves. It’s easy to let frustration or fatigue color our view of patients who return to the ED again and again. But we can’t lose sight of the fact that addiction is a chronic, relapsing disease. People need multiple chances. They need us to keep showing up.

When we offer MAT in the ED, we send a clear message: we see you, we understand what you’re going through, and we’re here to help. That message matters more than we sometimes realize.

I’ve made it a personal mission to ensure that my approach to addiction medicine reflects the same level of professionalism, integrity, and empathy that I bring to every other aspect of my practice. MAT is not a loophole or a shortcut. It’s evidence-based care, and it saves lives.

We still have a lot of work to do. We need better systems, better training, and better follow-up resources. But we don’t have to wait for the perfect setup to start helping people. We can begin right now, with the tools we have, in the places we already work.

The emergency department is many things: chaotic, fast-paced, unpredictable. But it’s also a place of hope. Every shift, we see patients at their most vulnerable. We have a responsibility—and a real opportunity—to meet them with empathy and offer something more than a temporary fix.

Starting MAT at first contact isn’t just good medicine—it’s the right thing to do. And it’s something I will continue to advocate for, one patient at a time.

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