Journal Article

Using short-acting opioids to relieve opioid withdrawal in hospital

Thakrar, Ashish P., Kleinman, Robert A.

2023

Overview

A 35-year-old woman with multiple substance use disorders, including opioids, methamphetamine, cocaine, and alcohol, presented to the hospital with suicidal ideation and severe opioid withdrawal. She had a history of previous suicide attempts and unintentional opioid overdoses. The patient had recently stopped taking methadone and slow-release oral morphine and reported high use of intravenous fentanyl. She also had a history of various psychiatric disorders. The patient's withdrawal symptoms were initially managed with hydromorphone, and then methadone and slow-release oral morphine were initiated. The case highlights the challenges faced by patients with opioid use disorder in the hospital setting. There are no specific guidelines for managing fentanyl withdrawal in hospitals, and undertreated withdrawal symptoms and stigma often lead patients to leave the hospital prematurely. Short-acting opioids can be used as adjuncts to relieve withdrawal symptoms in these patients, but dosing must be tailored to individual patient factors. Further research is needed to improve the management of fentanyl withdrawal in hospitals.

• Publisher: Elsevier Inc,CMA Impact Inc,CMA Impact, Inc
• Subject: Analgesics, Opioid - therapeutic use / Benzodiazepines / Care and treatment / Chronic Pain - drug therapy / Communities of practice / Diagnosis / Drug abuse / Drug overdose / Drug stores / Drug use / Drug withdrawal / Drug withdrawal symptoms / Emergency medical care / Fentanyl / Hospitals / Humans / Iatrogenesis / Internal Medicine / Methadone / Morphine / Narcotics / Narcotics - therapeutic use / Opioid-Related Disorders - drug therapy / Patients / Polypharmacy / Post traumatic stress disorder / Practice / Substance Withdrawal Syndrome - drug therapy / Suicidal behavior / Suicides & suicide attempts / Testing