Seeing the Patient Beyond the Crisis
As an emergency physician practicing in rural communities, I’ve learned to recognize both the urgency of the moment and the broader story each patient carries with them. Many people come to the emergency department during their lowest point—physically, emotionally, and mentally. And when it comes to substance use, especially opioid addiction, those moments of crisis are often the rare windows we have to reach someone before it’s too late.
Traditionally, emergency medicine has been about stabilization. We stop the bleeding, reverse the overdose, control the heart attack. Once the patient is medically safe, we discharge or refer them. But when it comes to addiction, that model leaves something critical out. For someone struggling with opioid use disorder, simply reversing an overdose or managing withdrawal isn’t enough. We need to move the conversation—and the care—beyond the crisis. That’s where Medication-Assisted Treatment, or MAT, comes in.
Changing the Definition of “Emergency”
In a rural ED setting, where options are often limited and follow-up care can be scarce, we have to think differently. For a long time, we treated addiction like something to be dealt with outside the ED. We didn’t see it as our responsibility to initiate long-term treatment. But now we know better.
Opioid use disorder is a chronic disease, and like any chronic disease, early intervention can make a real difference. If a patient came in with diabetic ketoacidosis, we wouldn’t just stabilize them and send them off without a plan. We’d start them on insulin, educate them, and connect them to care. The same should be true for addiction.
With MAT, we have the tools to do that. Initiating buprenorphine in the ED can help someone stabilize not just medically, but psychologically. It gives them time—time to consider recovery, time to weigh their options, and most importantly, time to stay alive long enough to make those decisions.
The Power of a First Dose
I can’t count how many patients I’ve seen who came in sick from withdrawal, scared, and unsure of what to expect. For many of them, just being treated with respect in the ED is a first. When we take the time to listen, when we offer that first dose of MAT, something shifts.
I’ve seen people who arrived agitated and hopeless become calm, alert, and engaged within an hour. That first dose doesn’t just ease withdrawal—it can restore dignity. It signals that we’re not just patching them up and sending them out the door. We’re offering them a real path forward.
Of course, one dose won’t fix everything. But it can be a catalyst. A bridge from crisis to care. And in rural areas, where specialty clinics might be hours away and waitlists weeks long, that bridge can be the difference between life and death.
A System That Needs to Catch Up
The reality is, our healthcare system isn’t always designed for continuity—especially in rural settings. Once a patient leaves our department, we often don’t know what happens next. Are they able to get a follow-up appointment? Can they find a pharmacy that stocks buprenorphine? Do they have transportation, support, a safe place to recover?
These questions are tough, and sometimes the answers are frustrating. But that doesn’t mean we give up. In fact, it means we lean in harder. We work with local health departments, community providers, and peer recovery coaches. We explore telehealth options. We advocate for funding, for programs, for systems that don’t leave our patients behind just because they live in rural ZIP codes.
Redefining Success in the ED
For too long, success in the ED has been measured by metrics: wait times, throughput, readmission rates. But there’s another kind of success we should be talking about—the kind you don’t always see on a chart.
Success is a patient returning weeks later, not in crisis, but just to say thank you. Success is a young man who got his first dose of buprenorphine in our department and now has a job, a sponsor, and a reason to get up in the morning. Success is watching someone walk out our doors with more hope than they had when they walked in.
These moments are what keep me going. They remind me why I do this work—and why it matters so much in places that are often overlooked or under-resourced.
Why It’s Personal
As someone who’s dedicated decades to emergency medicine, I believe we owe it to our patients to meet them where they are—not just geographically, but emotionally and medically. Rural America is in the middle of an addiction crisis, and if we wait for perfect systems or ideal conditions, we’ll lose too many people along the way.
I didn’t go into medicine to treat symptoms and send people on their way. I became a physician to heal, to help, to change lives when and where I can. And in today’s emergency departments, MAT is one of the most powerful tools we have to do that.
We’re not just managing overdoses anymore. We’re planting the seeds of recovery. One patient, one dose, one chance at a time.