Treatment of Inpatient Opioid Withdrawal with Short-Acting Full Agonist Opioids at a Safety-Net Hospital

Gabriela Steiner; Leslie W Suen; Marlene Martin; Sasha Skinner; Pierre Crouch; Oanh K Nguyen; Kristin Slown; Alexander Logan

doi:10.1007/s11606-024-09321-5

Treatment of Inpatient Opioid Withdrawal with Short-Acting Full Agonist Opioids at a Safety-Net Hospital

J Gen Intern Med. 2025 Jan 6. doi: 10.1007/s11606-024-09321-5. Online ahead of print.

Authors

Gabriela Steiner¹, Leslie W Suen¹, Marlene Martin¹, Sasha Skinner², Pierre Crouch², Oanh K Nguyen¹, Kristin Slown², Alexander Logan³

Affiliations

¹ University of California, San Francisco, 1001 Potrero Avenue, Bldg 5 Rm 5H06, San Francisco, CA, 94110, USA.
² Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, USA.
³ University of California, San Francisco, 1001 Potrero Avenue, Bldg 5 Rm 5H06, San Francisco, CA, 94110, USA. Alexander.Logan@ucsf.edu.

PMID: 39762677
DOI: 10.1007/s11606-024-09321-5

Abstract

Background: Fentanyl use leads to increased opioid tolerance in people with opioid use disorder, complicating management of opioid withdrawal syndrome. While accepted as gold standard, methadone and buprenorphine may be insufficient to treat acute opioid withdrawal. Short-acting full agonist opioids (SAFAO) may improve treatment in the acute care setting.

Aim: Characterize use of SAFAO to treat opioid withdrawal syndrome for inpatients.

Setting: Urban safety-net hospital.

Participants: Inpatients with opioid use disorder.

Program description: Addiction Consult Team offers SAFAO to manage opioid withdrawal syndrome.

Program evaluation: We performed retrospective chart review of hospitalizations (n = 124) for patients with opioid use disorder who received SAFAO between March and June 2023. Patients received methadone or buprenorphine during 94% of hospitalizations. On average, 278 mg (SD 407 mg) oral morphine equivalents (OMEs) of SAFAO were administered daily during the first hospitalization week. Daily Clinical Opiate Withdrawal Scale scores and SAFAO OMEs were inversely correlated (Spearman rank correlation = - 0.96, p = 0.003). Five hospitalizations exhibited adverse events (AEs).

Discussion: Use of methadone/buprenorphine did not alleviate the need for SAFAO, suggesting that SAFAO administration may be an important intervention for opioid withdrawal. Use of escalating OMEs of SAFAO was associated with reduced withdrawal severity. This practice was well-tolerated with few AEs.

Keywords: medications for opioid use disorder; opioid use disorder; ppioid withdrawal syndrome; substance use disorder.