Starting Inpatient Medication for Opioid Use Disorder in the Fentanyl Era

Traditional protocols for initiating medication for opioid use disorder (MOUD) were developed before fentanyl and other high-potency synthetic opioids became dominant in the illicit opioid supply. Because these drugs can lead to higher opioid tolerance, more prolonged withdrawal syndromes, and greater risk for precipitated withdrawal, many hospital clinicians have adopted newer MOUD initiation strategies without randomized trial data to back them. Now, a team of national addiction experts has issued a consensus statement on the appropriateness of these strategies.

Key Points

• Rapid methadone initiation (which involves higher starting doses, faster dose escalation, or both compared with traditional protocols) was considered appropriate f…