ORN Fall 2026 - Topics in Opioid Use Disorder: Innovations in Hospital-Initiated Methadone and Buprenorphine-Handout - ORN Fall 2026

Handout - ORN Fall 2026 - Buresh MD

Pdf Summary

This presentation reviewed innovations in hospital-initiated medications for opioid use disorder (MOUD), focusing on methadone and buprenorphine in the fentanyl era. It emphasized that hospitalization is a key opportunity to start treatment, yet only 15–20% of hospitalized patients with OUD receive MOUD. The talk highlighted that fentanyl has increased opioid tolerance and complicated buprenorphine initiation because of fear of precipitated withdrawal, while methadone titration may feel too slow for some patients.<br /><br />A mixed-methods study from Johns Hopkins Bayview found a three-fold increase in methadone selection from 2018 to 2022 among hospitalized patients with OUD. Patient preference was strongly shaped by prior experience: people who had positive prior methadone experiences were more likely to choose methadone, while those with positive buprenorphine experiences favored buprenorphine. Common reasons for avoiding or hesitating about buprenorphine included prior adverse initiation experiences and fear of precipitated withdrawal. Concerns about slow methadone titration were also common.<br /><br />A second retrospective study examined whether early methadone dose affected patient-directed discharge (PDD). Among hospitalized adults who received methadone within the first 72 hours, higher cumulative methadone doses in the first 24–48 hours were associated with lower odds of PDD. The findings suggest that faster, adequate methadone dosing may help better control withdrawal and keep patients engaged in care.<br /><br />The presentation also clarified hospital methadone regulations, noting that hospitals have more flexibility than outpatient opioid treatment programs, can administer methadone during hospitalization, and may dispense up to a 3-day supply at discharge under updated rules. Overall, the key message was that all hospitalized patients with OUD should be offered MOUD, with treatment choice and dosing tailored to patient preference, fentanyl exposure, and withdrawal severity.

Keywords

opioid use disorder

MOUD

methadone

buprenorphine

hospital initiation

fentanyl era

precipitated withdrawal

patient-directed discharge

withdrawal management

hospital regulations