Emergency rooms across the United States regularly treat patients with opioid use disorder and patients experiencing opioid overdose. Four to six million people in the US are estimated to have opioid use disorder. Over half of overdose related deaths in 2016 resulted from the use of opioids. The majority of deaths involved the use of fentanyl. There is an opioid epidemic plaguing the nation and with emergency rooms at the forefront of the proverbial battlefield; they can potentially play a key role in addressing the problem. Currently, there are three FDA approved, evidence-based medications for the treatment of opioid use disorder. These are buprenorphine, methadone and extendedrelease naltrexone. Buprenorphine induction in emergency room settings has shown great promise. Research suggests that it is an effective, safe and cost-effective treatment to initiate in emergency rooms. In order to successfully treat opioid use disorder and overdose in emergency rooms, they must have waivered providers and they must be equipped with the necessary resources. The VA Connecticut has been able to overcome some of the challenges to initiating buprenorphine in the emergency room setting and has established a feasible model for treating opioid overdose and managing opioid use disorder.