Ep 218 Substance Use Disorder in the ED – Stigma, Compassion and System Change

Emergency Medicine Cases

Dr. Anton Helman

Education, Health & Fitness, Courses, Medicine, Science

4.7 • 602 Ratings

🗓️ 19 May 2026

⏱️ 61 minutes

🔗️ Recording | iTunes | RSS

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Summary

Emergency physicians pride themselves on recognizing and treating life-threatening illness under pressure. Yet one of the most lethal, common, and treatable conditions presenting to our EDs still often receives fragmented, stigmatized care: substance use disorder. The opioid crisis has evolved into an era of increasingly toxic and unpredictable drug supplies, including ultra-potent synthetic opioids such as nitazenes. Between 2016 and 2021, more than 27,000 Canadians died from opioid toxicity, while opioid-related ED visits continue to rise sharply. Patients discharged with untreated opioid use disorder face mortality rates approaching 5% within 12 months. Despite this, substance use disorder is still not consistently approached with the same urgency and systems-based care as other chronic high-risk illnesses. In this episode, Dr. Bjug Borgundvaag, Tish Mizon and Kari Herbert discuss how stigma affects care in the ED and how trauma-informed communication, person-first language, compassionate care, peer navigators and Bridge-style addiction programs can improve outcomes for both patients and clinicians. Please support EM Cases ongoing Free Open Access Medical Education learning platform with a donation here: https://emergencymedicinecases.com/donation/

Transcript

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0:00.0	Emergency medicine is more than just ordered chaos.
0:04.5	From the recess room to the bedside, we are witness to it all.
0:07.9	And we're here to help you prepare for it.
0:10.3	Bringing you the brightest minds in emergency medicine from around the world for trusted,
0:14.8	tried, and true free open access medical education.
0:18.0	I'm Dr. Anton Hellman.
0:19.6	And I'm Dr. Katie Lynn. Katie, let's welcome the listeners
0:22.7	from our amazing EM community to the Emergency Medicine Cases podcast, shall we? Yeah. Or let's simply call it
0:28.7	EM cases. Okay, EM Cases. EM cases is brought to you by Shremi, the Schwartz-Rizman Emergency Medicine
0:35.6	Institute. That's a non-profit organization dedicated to improving EM care through high-quality research and education. The opinions expressed on this podcast are intended for information and education purposes only and should not be used to diagnose, treat, or prevent any medical condition, nor should they be used as a substitute for medical advice from qualified practicing physicians. First, just a quick word from our sponsor, Metricade, the experts in complex physician scheduling since 2012. I've been using
0:55.8	Metricade's incredible scheduling system for more than a decade, and it's been a game changer
0:59.9	for me and my colleagues. Shift work comes with its challenges, but Metricade helps minimize
1:05.0	the drawbacks by ensuring fair distribution of shifts while integrating circadian rhythm-friendly recovery time into its methodology,
1:13.1	preserving your precious sleep so that you can perform at your best. Go to metricade.com slash
1:18.8	EM cases to see how Metricade can make your scheduling fair, improve your sleep, and your performance.
1:25.5	That's metricade.com slash emcases.
1:30.5	We all went into emergency medicine to save lives, right? We chased the rush of the resuscitation,
1:36.4	the airway, the trauma, the septic shock, because those are the moments where our actions
1:40.9	make a real difference. But there's another lethal, entirely treatable condition that some of us see on just about
1:50.0	every shift that seldom gets our full attention unless the patient's crashing, and that is
1:55.3	substance use disorder.
1:57.5	I want to share a quote with you from more than a decade ago, and here it goes.
	...

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