Hospital-Based Management of Opioid Use Disorder in the Fentanyl Era—The Role and Limits of Expert Consensus - Summary - MDSpire

Hospital-Based Management of Opioid Use Disorder in the Fentanyl Era—The Role and Limits of Expert Consensus

  • By

  • Itai Danovitch

  • May 7, 2026

  • 0 min

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Objective:

To characterize the contemporary initiation of medications for opioid use disorder (MOUD) in hospitalized patients amidst the fentanyl crisis, highlighting the urgency of adapting protocols.

Key Findings:
  • High consensus on modifying existing protocols for MOUD initiation, particularly for heavy fentanyl users, indicating a need for flexibility in clinical practice.
  • Support for both traditional and alternative induction pathways for buprenorphine, including microinduction and macrodosing, reflecting diverse clinical strategies.
  • Hospital practices are evolving faster than formal guidelines due to the changing drug landscape, necessitating ongoing adaptation.
Interpretation:

Consensus findings highlight the need for ongoing re-evaluation of protocols in response to complex clinical scenarios and evolving drug markets, stressing the importance of flexibility in treatment approaches.

Limitations:
  • Vignette-based consensus may oversimplify complex clinical scenarios, such as those involving co-occurring medical conditions.
  • Consensus does not provide comprehensive guidance for medically complex patients with OUD, which may lead to inadequate treatment in real-world settings.
Conclusion:

There is a pressing need for updated clinical guidance and evidence generation to address the challenges of MOUD initiation in the context of the fentanyl crisis, emphasizing the urgency of adapting to new clinical realities.

Original Source(s)

Hospital-Based Management of Opioid Use Disorder in the Fentanyl Era—The Role and Limits of Expert Consensus

  • by Itai Danovitch

  • May 7, 2026

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