Clinical Scorecard: Guidelines for Initiating Medications for Opioid Use Disorder in Hospital Settings: A Consensus Overview
At a Glance
Category
Detail
Condition
Opioid Use Disorder (OUD)
Key Mechanisms
Initiation of medications for opioid use disorder (MOUD) to reduce overdose deaths, particularly in the context of high-potency synthetic opioids (HPSOs).
Target Population
Patients hospitalized with opioid use disorder, particularly those using high-potency synthetic opioids.
Care Setting
Hospital settings
Key Highlights
Hospitalization is a critical moment for initiating MOUD.
Rapid and higher-dose methadone and buprenorphine initiation protocols are being utilized.
High-potency synthetic opioids complicate MOUD initiation due to tolerance and withdrawal severity.
Consensus on best practices was developed through a Delphi process involving addiction experts.
Limited data exists supporting current practices, primarily from observational studies.
Guideline-Based Recommendations
Diagnosis
Assess opioid use disorder in hospitalized patients, particularly those using high-potency synthetic opioids.
Management
Utilize rapid initiation protocols for methadone and buprenorphine based on withdrawal symptoms.
Monitoring & Follow-up
Frequent monitoring of opioid withdrawal and medication safety during hospitalization.
Risks
Higher risk of buprenorphine-precipitated withdrawal due to the lipophilicity of HPSOs.
Patient & Prescribing Data
Hospitalized patients with opioid use disorder, particularly those with high-potency synthetic opioid use.
High-dose initiation of buprenorphine may be necessary after objective withdrawal symptoms.
Clinical Best Practices
Implement high-dose initiation protocols for buprenorphine and methadone in hospital settings.
Monitor patients closely for withdrawal symptoms and medication effects.
by Shawn M. Cohen, Elana Straus, David A. Fiellin, Jamie L. Pomeranz, Joji Suzuki, Jeanette M. Tetrault, Melissa B. Weimer, E. Jennifer Edelman, Paul J. Joudrey
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