ACEP Pain Management and Addiction Medicine Section Spotlight: On Shift Tools, Evolving Drug Use, and the Next Wave of ED Pain Care

This ACEP Early Career Physicians spotlight features Dr. Laurel Barr in conversation with Dr. Reuben Strayer (Immediate Past Chair) on the role of the Pain Management and Addiction Medicine Section in helping emergency physicians care more effectively for pain and substance use disorders. It also previews an important shift for the group, as pain management moves toward its own Member Interest Group and addiction medicine continues expanding its emergency department focus.

What the Section offers

At its core, the Section treats pain management and addiction care as essential ED work. It supports emergency physicians with practical guidance, evidence based resources, and a professional network that helps members improve care, build local programs, and respond to a rapidly changing clinical landscape.

Why this Section matters for early-career physicians

Early career EPs see this every day: pain crises, opioid overdose and withdrawal, alcohol related injury and withdrawal, nicotine dependence, and patients who depend on the ED for care. Dr. Strayer emphasizes that EM is moving from treating the consequences of addiction to treating addiction itself, starting in the ED and linking patients to ongoing care. This section is your home base to build skills and help your department do it better.

Resources you can use now

The section produces clinical guidance that helps clinicians act in the moment, including resources on starting buprenorphine in the ED. As Dr. Strayer emphasizes, this landscape evolves quickly, especially with fentanyl changing withdrawal patterns. The focus is keeping EPs current on OUD identification, safe and effective buprenorphine use, and department workflows that enable initiation and follow up.

A fast moving drug landscape that keeps changing

One of the most practical points is that the substance landscape shifts quickly, and the ED is often the first to see it. Dr. Strayer highlights changes including the transition from heroin to fentanyl, fentanyl mixed with xylazine or medetomidine and evolving withdrawal presentations, emerging intoxicants such as kratom, and nicotine use trends driven by vaping. The section provides actionable guidance through clinician toolkits and shared best practices to help departments keep up.

Methadone in the ED and the 72 hour rule

Looking ahead, the section is expanding education around methadone initiation and ED based bridging as federal policy and implementation pathways continue to change. Dr. Strayer notes that many emergency physicians have less familiarity with methadone than buprenorphine. With increasing use of the 72 hour rule, the section is focused on actionable resources that clarify when bridging is permitted, support appropriate initiation, and strengthen connections to community methadone clinics.

Advocacy priorities: making the right care possible and sustainable

Good care is not just clinical, it is structural. The section focuses on advocacy that removes barriers and makes evidence based addiction care doable in the ED. That includes smarter regulation and reimbursement, support and payment for EP initiated treatment, better access to effective analgesics and training, and clear guidance when laws and policies change.

How to get involved

The best part is how easy it is to plug in. Join the section in your ACEP member profile, hop on the email list where most of the collaboration happens, and raise your hand when documents, policies, or new programming need input. Then meet up with section leaders at ACEP events to build your mentor and collaborator network.

Closing takeaways

Pain and addiction have lived under one roof for years, especially around opioids. Dr. Strayer explains that the fields are now separating into clearer tracks. The plan is to move pain management into a Member Interest Group first, with a path to its own section, giving pain focused clinicians a dedicated home for education and leadership. Excitement is growing in ED pain care with more interest in pain fellowships, wider adoption of ultrasound guided nerve blocks, and new medications and approaches on the horizon.

Visit the Pain Management and Addiction Medicine Section