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

May 19, 2026

AI Summary

5 min read

Emergency medicine is built for the resuscitation, the airway, the trauma—the moments where a physician’s actions make an immediate, visible difference. But there is another lethal, entirely treatable condition that shows up on nearly every shift and rarely gets the same urgency: substance use disorder. As Dr. Anton Hellman opens this episode, he cites a staggering statistic: when a patient with substance use disorder is discharged untreated, roughly 5% will die within 12 months. That mortality rate rivals or exceeds that of many conditions that trigger an automatic workup and close follow-up. Yet these patients are often deprioritized, disbelieved, and discharged without a plan. The central argument of this conversation—featuring emergency physician and researcher Dr. Bug Borgundvaag alongside two guests with lived and professional experience, Tish Mizon and Kerry Herbert—is that the emergency department is not just a place to stabilize acute crises but a critical, often last-chance opportunity to intervene in a lethal illness. The barrier is not a lack of effective treatment; it is stigma.

How Stigma Sabotages Care

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What you'll learn

1 (00:18) **Episode Introduction & The Challenge** - Hosts Anton Helman and Katie Lynn introduce the episode's focus on substance use disorder (SUD) in the ED, framing it as a lethal but treatable condition that often doesn't get the same urgency as other emergencies.
2 (04:59) **Introducing the Guests and Their Perspectives** - Three guests are introduced: Dr. Bug Borgenvog (EM physician/researcher), Tish Mizon (outreach educator with personal/familial experience), and Kerry Herbert (substance use counselor with lived experience of SUD).
3 (07:44) **Why SUD is in the ED's Wheelhouse** - The guests explain why emergency clinicians must own this problem, focusing on the ED as a critical, often only, point of contact for this population.
4 (10:44) **Patient Voices: "I'd Rather Die Than Go to the ER"** - Tish and Kerry relay the devastating experiences of patients, revealing how stigma creates a barrier that often makes the ED a place of last resort.
5 (16:09) **Unpacking Stigma on the Ground** - The conversation moves to specific examples of how stigma manifests in the ED, from physical placement to language.
6 (20:37) **The Research: A Participatory Action Study** - Bug summarizes his qualitative study, which involved interviewing 51 patients and over 40 clinicians across four EDs to understand barriers to care.
7 (26:24) **Geography is Destiny: Where Patients Are Placed** - The discussion focuses on how the physical location of a patient in the ED dictates the quality of care they receive.

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Guests on this episode

Anton Hellman

Show Notes

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/