Rapid Clinical Updates: Inpatient Management of Opioid Withdrawal in the Fentanyl Era-Presentation

Video Transcription

Video Summary

The talk, <strong>“Treating Opioid Withdrawal in the Fentanyl Era,”</strong> focused on practical inpatient management of opioid withdrawal, especially for patients using fentanyl. The speakers emphasized that fentanyl use has changed withdrawal patterns because the drug is highly lipophilic, can accumulate in body fat, and may cause <strong>prolonged, unpredictable withdrawal</strong> rather than the more rapid course seen with heroin.

A major theme was the importance of <strong>non-stigmatizing, person-first language</strong> in documentation and conversation, since stigmatizing terms can worsen care and discourage patients from seeking help. The presenters also highlighted that patients with opioid use disorder are much more likely to have <strong>self-directed discharges</strong>, often because of undertreated withdrawal, pain, and stigma.

For assessment, they reviewed the <strong>Clinical Opioid Withdrawal Scale (COWS)</strong>, while noting it should not replace bedside evaluation and does not capture cravings well. Cravings were described as an important and legitimate treatment target.

For treatment, they stressed that <strong>opioid withdrawal must be treated with opioids</strong>. Non-opioid adjuncts like clonidine, hydroxyzine, ondansetron, and loperamide can help symptoms but are usually insufficient alone. Methadone and buprenorphine remain key medications for opioid use disorder, but in the fentanyl era they often need to be paired with <strong>short-acting full agonist opioids</strong> such as oxycodone or hydromorphone to adequately control withdrawal in the hospital.

They also briefly covered <strong>xylosine (“tranq”)</strong>, a fentanyl adulterant that may cause difficult wounds, sedation, hypotension, and withdrawal-like agitation.

Overall take-home message: <strong>recognize fentanyl withdrawal, use respectful language, and treat withdrawal aggressively and individually to keep patients safe and in care.</strong>

Keywords

opioid withdrawal

fentanyl era

inpatient management

person-first language

Clinical Opioid Withdrawal Scale

self-directed discharge

methadone

buprenorphine

short-acting opioids

xylazine