Treating Opioid Withdrawal in the Hospital: A Role for Short-Acting Opioids
Authors: Robert A. Kleinman, Sarah E. Wakeman
Journal: Annals of Internal Medicine (2021)

Ideas and OpinionsFebruary 2022Treating Opioid Withdrawal in the Hospital: A Role for Short-Acting OpioidsRobert A. Kleinman, MD and Sarah E. Wakeman, MDRobert A. Kleinman, MDCentre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada (R.A.K.)Search for more papers by this author and Sarah E. Wakeman, MDDivision of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, and Department of Medicine, Harvard Medical School, Boston, Massachusetts (S.E.W.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M21-3968 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The Controlled Substances Act and associated regulations prohibit U.S. clinicians from prescribing opioids, except buprenorphine, as treatment for opioid use disorder (OUD). Besides creating barriers to OUD treatment, this framework has constrained strategies for treating opioid withdrawal symptoms (OWS). Short-acting opioids are not recommended in U.S. guidelines for OWS management, and patients who receive treatment of OWS are typically provided with buprenorphine, methadone, or nonopioid medications (1).The treatment of OWS among hospital inpatients has 3 principal clinical objectives: 1) relieve patient suffering and distress; 2) enable patients to remain in the hospital for medically necessary care; and 3) facilitate ...References1. American Society of Addiction Medicine. ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update. ASAM; 2020. Google Scholar2. Liebschutz JM, Crooks D, Herman D, et al. Buprenorphine treatment for hospitalized, opioid-dependent patients: a randomized clinical trial. JAMA Intern Med. 2014;174:1369-76. [PMID: 25090173] doi:10.1001/jamainternmed.2014.2556 CrossrefMedlineGoogle Scholar3. 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[PMID: 25944526] doi:10.1111/dar.12270 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada (R.A.K.)Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, and Department of Medicine, Harvard Medical School, Boston, Massachusetts (S.E.W.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-3968.Corresponding Author: Robert A. Kleinman, MD, Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, ON M6J 1H4, Canada; e-mail, robert.[email protected]ca.Author Contributions: Conception and design: R.A. Kleinman, S.E. Wakeman.Drafting of the article: R.A. Kleinman, S.E. Wakeman.Critical revision for important intellectual content: R.A. Kleinman, S.E. Wakeman.Final approval of the article: R.A. Kleinman, S.E. Wakeman.Administrative, technical, or logistic support: R.A. Kleinman.This article was published at Annals.org on 23 November 2021. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics February 2022Volume 175, Issue 2Page: 283-284KeywordsDrugsHospital medicineInpatientsOpioid addictionOpioid use disorderOpioidsOutpatient clinicsOutpatientsPatientsSafety ePublished: 23 November 2021 Issue Published: February 2022 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...