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Emergency Department Impact Spotlight
How Dr. Laura Haselden Is Building a Culture of Comfort Around Buprenorphine at St. Mary’s
- Published
- August 31, 2026
- Facility
- MedStar St. Mary’s Hospital
- Region
- Southern Maryland
- Featuring
- Dr. Laura Haselden, Emergency Physician, MedStar
Tagged
- Southern Maryland
- Initiation/continuation of addiction medications
- Identification and engagement
Inclusion is not an endorsement
The Maryland Department of Health shares this account to highlight practices other facilities may find useful. Appearing in this series is not an endorsement, recommendation, certification, or approval of any hospital, health system, provider, vendor, or program by the Maryland Department of Health or the State of Maryland. Descriptions and figures are provided by the participating facility.
“My attitude is sort of like — stigmatizing these patients makes your life harder. So stop doing it.”
Dr. Laura Haselden works nights. It's a detail that matters more than it might seem — overnight, the safety net that daytime clinicians rely on largely disappears. Methadone clinics are closed and can't confirm doses, consult services may be less staffed, and the addiction-trained colleagues Haselden might otherwise call on are asleep. For most of her career treating opioid use disorder in the emergency department, she's been the one on shift when a patient arrives in withdrawal, with none of that backup available. An emergency physician credentialed across MedStar's Baltimore, D.C., and Southern Maryland facilities, Haselden has spent the past several years serving as an informal buprenorphine champion at St. Mary's — one of a handful of clinicians across the nine-hospital system who has taken it upon herself to close the gap between what the evidence says works and what actually happens at the bedside.
Standardizing What Works
Haselden's clearest success has been building a standardized buprenorphine initiation protocol for the emergency department. Since 2019, she has developed order sets, discharge paperwork, and annual provider education that walk clinicians through dosing based on the Clinical Opioid Withdrawal Scale (COWS), removing the guesswork that keeps many physicians from starting the medication at all. "We've just developed a sort of standard... kind of a one-size-fits-all protocol that we've pushed really hard," she explained. The results speak for themselves: a steady increase in both ED-initiated and discharge buprenorphine prescriptions across the system, driven less by any single intervention than by consistency and repetition. As Haselden put it, changing physician behavior "is a lot of repetition. It's a lot of institutional pressure" — but it works.
The second program she points to is St. Mary's peer recovery coach model, including the Overdose Survivor Outreach Program (OSOP). Peers, she noted, "touch all of these patients" in a way no single physician can. Where peer relationships are strong, they've become an informal referral and education network that helps close gaps in physician knowledge and patient trust alike. It's not without its challenges—turnover among peer staff is high, and some peers still carry an abstinence-only orientation that can limit harm reduction conversations—but Haselden considers the program one of the more durable wins in an otherwise resource-strapped environment.
The Barriers That Remain
For all the progress at the emergency department level, Haselden is candid about where the system still falls short. Inpatient buprenorphine uptake lags significantly, particularly at St. Mary's, where she is not funded to provide education. Many physicians there trained before 2023, when a federal X-waiver requirement still restricted who could prescribe the medication, so they never learned to manage it during their training. The result is a familiar and frustrating pattern: patients started on buprenorphine in the emergency department are sometimes discontinued once admitted, simply because inpatient teams are unfamiliar with the drug's safety profile and fear precipitated withdrawal. "You're not going to overdose if you go too fast," Haselden said, "but providers don't necessarily know that."
Grant funding structures compound the problem. Most of MedStar's addiction work is funded on six-to-12-month cycles concentrated in the Baltimore region, leaving St. Mary's and Southern Maryland with little dedicated support. Other challenges include when pharmacies require prior authorizations, methadone clinics without reliable after-hours coverage, and treatment for pregnant patients. And workforce retention is its own barrier: most ED physicians commute from the D.C. area, and full-time local staffing is rare outside of families connected to the nearby naval base.
Haselden's approach to these gaps has been pragmatic rather than perfect. She leans on relationships built over years of night shifts, uses system-wide leadership emails to reinforce protocol adoption, and treats every clinical practice guideline as a floor rather than a ceiling: "Here's a beginner's guide, but also if you're not a beginner, go crazy." The goal isn't to eliminate clinical judgment or individualized care—it's to make sure no physician has to start from zero.
What other Maryland Hospitals Can Take Away
Haselden's advice to other systems starts with stigma reduction, framed in practical rather than moral terms. "My attitude is sort of like—stigmatizing these patients makes your life harder. So stop doing it," she said, arguing that reducing friction for physicians is often a more effective lever than appeals to compassion alone. Beyond that, she points to two structural fixes: protocol-izing everything, so clinicians without addiction expertise still have a reliable path to follow, and securing leadership buy-in early, so that adoption is reinforced from the top rather than left to individual champions to sustain alone.
For policymakers, Haselden's experience points to a clearer need: sustainable, system-wide addiction service lines, modeled on how hospitals already staff cardiology or neurosurgery, with dedicated billing and reimbursement pathways, rather than reliance on a small number of unpaid champions absorbing the work on top of full clinical schedules. She also flagged upfront (rather than retroactive) grant funding, expanded tele-addiction consult models, and Maryland's recent move toward EMS-initiated buprenorphine as promising directions that could meaningfully reduce hospital utilization and reach patients in the critical window right after an overdose reversal.
"There's a lot of work to be done," Haselden said, "but I'm glad we're still having these conversations."
By the numbers
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2019the year Haselden began building standardized order sets, discharge paperwork, and provider education
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COWSthe Clinical Opioid Withdrawal Scale that anchors the protocol’s dosing guidance
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9hospitals in the MedStar system, where a handful of clinicians drive buprenorphine adoption
Figures reflect what the interviewee reported and are provided by the participating facility.
What other Maryland hospitals can take away
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Start with stigma reduction, framed practically. “My attitude is sort of — stigmatizing these patients makes your life harder. So stop doing it,” Haselden said, arguing that reducing friction for physicians is often a more effective lever than appeals to compassion alone.
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Protocolize everything, so clinicians without addiction expertise still have a reliable path to follow.
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Secure leadership buy-in early, so adoption is reinforced from the top rather than left to individual champions to sustain alone.
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Promising directions: upfront rather than retroactive grant funding, expanded tele-addiction consult models, and Maryland’s recent move toward EMS-initiated buprenorphine. “There’s a lot of work to be done,” Haselden said, “but I’m glad we’re still having these conversations.”
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