Understanding a New Kind of Emergency

For most of my career, I associated emergency medicine with heart attacks, trauma, strokes, and acute crises that needed immediate interventions. But over the last decade—especially in rural emergency departments—something changed. The emergencies didn’t stop, but another crisis started showing up more and more: opioid addiction.

At first, it was subtle. A young adult brought in by EMS, unresponsive. A patient with vague complaints, restless in the exam room, clearly in withdrawal. A repeat visitor who’d overdosed—again. The signs became more frequent, and it was clear we weren’t just facing isolated events. This was a public health epidemic, and it was coming through the doors of my ER every week.

Shifting from Stabilization to Support

Traditionally, emergency physicians stabilize, treat, and move on. That’s the nature of the job. But with opioid use disorder, I realized that approach wasn’t enough. We could revive someone with naloxone, monitor them, and send them on their way—but where were they really going? Too often, they were heading right back into danger, without a plan, without help, and without hope.

That’s when I began to seriously explore the role of Medication-Assisted Treatment (MAT) in the ED. I had heard of it before—mostly in academic settings or outpatient clinics—but it wasn’t something we talked about much in emergency circles. Especially not in rural areas. But the more I learned, the more I believed that this was something we needed to offer our patients—not as a handout, but as a lifeline.

The First Conversation Changed Me

I’ll never forget the first patient I treated with MAT in the ED. She was in her early thirties, terrified, shaking, and exhausted from withdrawal. Her story was familiar—an injury years earlier, a legitimate prescription, a slow slide into dependence, and then the hard fall into heroin.

She didn’t want a lecture. She didn’t want judgment. She just wanted to feel better and find a way out.

I offered her buprenorphine, explained what it could do, and walked her through the process. Within hours, she was calmer, clearer, and—most importantly—open to help. We connected her with a local MAT provider, arranged a follow-up, and gave her something she hadn’t had in a long time: a starting point.

That moment changed me as much as it changed her.

Rural Realities and Urgent Gaps

Practicing medicine in rural America has always come with challenges—scarce specialists, long distances, and limited mental health resources. When it comes to addiction treatment, those gaps are even wider. In some of the communities I serve, there is no addiction clinic nearby, no psychiatrist on call, and very few primary care providers who are trained or comfortable managing MAT.

That means the emergency department becomes the only touchpoint for many patients struggling with addiction. For some, we are their first—and only—chance at getting into treatment.

This responsibility can be overwhelming, but it’s also an opportunity. By initiating MAT in the ED, we’re not just treating symptoms—we’re opening a door. We’re showing patients that we see them as people, not as problems.

Overcoming Stigma Within and Without

One of the biggest barriers I faced early on wasn’t medical—it was cultural. There’s still stigma around addiction, even in the healthcare system. I’ve heard colleagues question whether MAT “replaces one drug with another.” I’ve had patients apologize for needing help, as if their illness was a personal failure rather than a medical condition.

We need to change that narrative. Addiction is a chronic disease, not a moral flaw. Treating it with evidence-based tools like buprenorphine is no different than treating high blood pressure or diabetes. We wouldn’t shame someone for needing insulin. Why would we shame them for needing help with opioids?

In rural communities, where privacy is scarce and judgment can come quickly, that stigma cuts even deeper. That’s why it’s so important to approach every patient with compassion and to back that compassion with action.

Compassion Isn’t Complicated

At its core, this work isn’t about protocols or paperwork. It’s about empathy. It’s about being present in someone’s lowest moment and offering them a way forward. It’s about recognizing that every patient we treat has a story, and often, that story includes pain we’ll never fully understand.

But we don’t need to understand everything to care. We just need to show up, stay curious, and be willing to meet people where they are.

MAT in the emergency department isn’t a magic fix. It’s a first step. But for many of my patients, that first step is everything.

A Personal Mission

Over the years, I’ve received awards, held leadership positions, and worked in a range of clinical settings. But few things have felt as meaningful as helping someone start recovery in the emergency room. I’ve seen lives change—not overnight, but slowly, steadily—because someone took them seriously, treated them with dignity, and offered them a medical path forward.

Integrating addiction medicine into emergency care isn’t easy. It requires time, training, and commitment. But it’s worth it. Every single time.

As physicians, we’re called to do more than treat—we’re called to heal. And sometimes, healing begins with one conversation, one dose, and one act of compassion.