Managing Opioid Use Disorder in Hospitals During the Fentanyl Crisis

Overview

Expand on the specific modified protocols for methadone and buprenorphine initiation.

Background

The opioid crisis, particularly driven by illicitly manufactured fentanyl, poses significant challenges in hospital settings. Patients with opioid use disorder often present with complex medical issues that complicate treatment. As traditional protocols may not suffice, expert consensus can guide clinicians in adapting their approaches to better serve this vulnerable population.

Data Highlights

No specific numerical data was provided in the source material.

Key Findings

• High consensus among experts for accelerated methadone titration in heavy fentanyl users.
• Support for both traditional and alternative buprenorphine induction pathways, including microinduction and macrodosing.
• Clinical scenarios in the survey highlight the need for individualized treatment approaches.
• Standardized protocols may lower barriers to initiating medications for opioid use disorder.
• Ongoing re-evaluation of established protocols is necessary as clinical contexts evolve.

Clinical Implications

Clinicians should be aware of the limitations of existing protocols and the importance of individualized patient assessments. The findings suggest that adapting treatment strategies based on expert consensus can enhance care for hospitalized patients with opioid use disorder.

Conclusion

The evolving nature of opioid use and withdrawal management necessitates ongoing adaptation of clinical protocols. Expert consensus provides a valuable framework for improving the initiation of medications for opioid use disorder in hospital settings.

Related Resources & Content

1. Cohen et al, JAMA Network Open, 2023 -- Managing Opioid Use Disorder in Hospitals During the Fentanyl Crisis
2. ADA News — Opioid epidemic reaches crescendo as COVID-19 stays center stage
3. the ophthalmologist — Ophthalmology’s Role in the Opioid Crisis
4. JAMA Network Open — Cost-Effectiveness of the START Hospital Addiction Consultation Service for Opioid Use Disorder Treatment
5. Opioid Use Disorder: Treating | Overdose Prevention | CDC
6. Management of Opioid Use Disorder and Associated Conditions among Hospitalized Adults: A Consensus Statement From the Society of Hospital Medicine
7. 42 CFR Part 8 Final Rule | SAMHSA
8. Emergency Department–Initiated Buprenorphine for Opioid Use Disorder: A Randomized Clinical Trial | JAMA | JAMA Network
9. High-Dose Buprenorphine Initiation in the Emergency Department Among Patients Using Fentanyl and Other Opioids | Substance Use and Addiction Medicine | JAMA Network Open | JAMA Network
10. Buprenorphine-Precipitated Withdrawal Among Hospitalized Patients Using Fentanyl | Clinical Pharmacy and Pharmacology | JAMA Network Open | JAMA Network
11. Rapid Inpatient Methadone Induction in the Fentanyl Era: A Systematic Review of Safety, Efficacy, and Protocols for Hospitalized Patients with Opioid Use Disorder | Current Addiction Reports | Springer Nature Link
12. High-Dose Buprenorphine Treatment in the Setting of Fentanyl | Clinical Pharmacy and Pharmacology | JAMA Network Open | JAMA Network
13. Medetomidine in the U.S. Illegal Fentanyl Supply Increasing Risk for Overdose and Severe Withdrawal Syndrome | HAN | CDC