Rapid Clinical Updates: Updates in Opiate Use Disorder: Advances in Therapies Across All Ages-Presentation

Video Transcription

Video Summary

This Society of Hospital Medicine webinar reviews inpatient updates in opioid use disorder (OUD) treatment across adults and adolescents, emphasizing that medications for OUD (MOUD) are the evidence-based, lifesaving standard of care. Speakers highlight the “fourth wave” opioid epidemic dominated by high-potency synthetic opioids (especially fentanyl) and frequent opioid–stimulant co-use, with widespread fentanyl contamination of non-opioid drugs. Major organizations (ASAM, SAMHSA, AAP, SAHM) stress that withdrawal management alone is not treatment and that MOUD should not be contingent on therapy.<br /><br />The session compares the three FDA-approved MOUD options: methadone (full agonist), buprenorphine (partial agonist), and naltrexone (antagonist). Methadone and buprenorphine reduce all-cause and overdose mortality, but interruption sharply increases death risk, underscoring the need to continue home MOUD during hospitalization. Access gaps are pronounced for adolescents despite recommendations, largely due to stigma and limited prescribers.<br /><br />Because fentanyl is lipophilic and persists in tissue, traditional “standard” buprenorphine inductions can trigger precipitated withdrawal. Clinicians are taught to recognize and treat precipitated withdrawal primarily by giving additional buprenorphine (often with clonidine and benzodiazepines; dexmedetomidine/ketamine may be options in some settings). Newer initiation strategies include high-dose (“macro”) rapid induction (escalating to 24–32 mg within hours) and low-dose (“micro”) induction with continuation of full-agonist opioids, useful for prolonged hospitalizations or significant pain.<br /><br />The speakers address stigma, pain control, and discharge harm reduction (naloxone, fentanyl test strips), and conclude that the “best” MOUD is the one the patient will accept and continue.

Keywords

opioid use disorder

medications for opioid use disorder

MOUD

fentanyl

opioid epidemic fourth wave

opioid stimulant co-use

inpatient buprenorphine induction

precipitated withdrawal

methadone

harm reduction naloxone fentanyl test strips