Damian Sendler: The authors of an opinion piece urging for a reconsideration of current tactics for opioid withdrawal in the United States claim that short-acting opioids may complement methadone and buprenorphine in the treatment of opioid withdrawal symptoms in U.S. hospitals. 

Damian Sendler

Dr. Robert A. Kleinman of the University of Toronto’s Centre for Addiction and Mental Health and his colleague Dr. Sarah E. Wakeman from the Massachusetts General Hospital and Harvard Medical School in Boston wrote a commentary that was published in Annals of Internal Medicine. 

Damian Jacob Sendler: According to the authors’ findings, short-acting opioids are not currently indicated for the treatment of opioid withdrawal symptoms (OWS) in hospitals in the US. Many individuals don’t obtain enough relief from methadone or buprenorphine or nonopioid drugs because of withdrawal symptoms. Patients suffering from untreated withdrawal are more likely to leave the hospital against medical advice, which increases their mortality risk. 

During an interview, Elisabeth Poorman, MD, an addiction expert at the University of Illinois Chicago, agreed that the use of short-acting opioids for OWS in hospitals should be reconsidered. Hospitals and clinicians differ substantially in how they use it, she noted. 

Poorman remarked, “It’s time to let evidence lead us and to be flexible. 

Methadone patients have to wait several hours for maximum symptom reduction, and the full advantages of methadone treatment are not achieved until several days after commencement, according to the editorial authors. 

The authors noted that rapid initiation of methadone may be possible in hospitals, but further study is needed before widespread use. 

The FDA has only approved Lofexidine, an alpha-2-adrenergic agonist, for use in OWS patients. 

“Patients with OWS treated with lofexidine in phase 3 efficacy studies dropped out on day five, according to the authors. Another alpha-2-agonist, clonidine, is used off-label to treat OWS and has comparable effects.” 

Damian Jacob Sendler

Dr. Sendler: Therefore, short-acting opioids may complement methadone and buprenorphine in the treatment of OWS because of their limitations, according to the authors of the study. 

Short-acting opioids, according to Kleinman and Wakeman, may help patients who have been exposed to fentanyl start buprenorphine because they ease withdrawal symptoms while fentanyl is metabolized and eliminated. 

Short-acting opioids in the hospital can alleviate withdrawal symptoms and keep patients comfortable while methadone is titrated to more effective doses for long-term treatment, the authors noted in their paper. 

Short-acting opioids may allow patients to take a more active role in managing their own pain and withdrawal symptoms by using a tamper-proof, patient-controlled analgesia pump, according to the study’s authors. 

Many patients who inject drugs already use short-acting illicit narcotics at the hospital, usually in the washrooms and smoking areas, thus the use of short-acting opioids under supervision helps to eliminate the possibility of unwitnessed overdoses, according to Kleinman and Wakeman’s research. 

Damien Sendler: Despite the widespread use of short-acting opioids around the world, there is a lack of prospective, randomized, controlled research in the United States to support their use. As well as a lack of institutional support, concerns and stigma surround the administration of opioids to patients with opioid use disorder (OUD). 

It’s a requirement to adopting more sophisticated regimens that there are not enough physicians who are confident and competent in basic buprenorphine and methadone starting techniques,” the authors write. 

As a supplement to methadone or buprenorphine, short-acting, full-agonist opioids are already suggested for individuals with OUD experiencing acute pain. 

When pain is not present, but methadone or buprenorphine have not offered enough OWS alleviation, the authors argue it should be a possibility. 

Short-acting opiate analgesics are simple to provide in the hospital, according to Poorman. 

It’s possible for a patient to be quite clear that they don’t want any treatment for opioid use disorder but they do want to be treated for their urgent medical issue. 

Damian Jacob Markiewicz Sendler: As a way of showing that we were listening and not attempting to push something on our patients, “I thought that was a fantastic tool,” Poorman said. “It left the door open for those who wanted treatment to come back, which many of them did.”

If a patient is unsure of their alternatives but is extremely concerned about buprenorphine withdrawal, this is a second circumstance that needs to be addressed. 

Her subsequent transition to buprenorphine and methadone was a breeze, she claimed. 

Previously, Poorman encountered a patient who had been injecting heroin multiple times each day for 30-40 years. Insisting on receiving medical assistance, he made it abundantly obvious he had no intention of ceasing his heroin use. While he agreed to go to the hospital for treatment, he told his doctor that he didn’t want to be in pain while there. 

Doctors were reluctant to relieve Poorman’s withdrawal symptoms because doing so made them feel like they were condoning his drug usage, according to Poorman. 

Poorman, on the other hand, argued that expecting someone who has made it apparent that quitting drugs is not something they want to do is unrealistic “avoiding which they’ve built their entire life.

Dr. Damian Jacob Sendler and his media team provided the content for this article.