Hospital addiction clinicians reached consensus supporting rapid methadone initiation and several buprenorphine initiation strategies for patients with opioid use disorder using high-potency synthetic opioids, according to a May 7 study published in JAMA Network Open.
Researchers from the Yale School of Medicine in New Haven, Conn., surveyed 42 national experts in hospital-based addiction care using a two-round Delphi process conducted from January to April 2025. Participants treated a median of 200 hospitalized patients with opioid use disorder in the past year.
Here are three things to know:
- Experts agreed rapid methadone initiation was appropriate, along with high- and low-dose buprenorphine initiation practices. Traditional buprenorphine initiation was rated of uncertain appropriateness, while buprenorphine rescue after intentional naloxone-induced withdrawal was considered inappropriate.
- The panel also agreed that providing full agonist opioids, such as oxycodone or hydromorphone, was appropriate in several hospital scenarios, including managing continued opioid withdrawal during methadone initiation and bridging patients to buprenorphine initiation.
- The study authors said the findings reflect how hospital addiction practices have shifted in response to fentanyl and other high-potency synthetic opioids, despite limited randomized clinical trial evidence supporting many of the newer treatment approaches.
At the Becker's Fall Behavioral Health Summit, taking place November 4–5 in Chicago, behavioral health leaders and executives will explore strategies for expanding access to care, integrating services, addressing workforce challenges and leveraging innovation to improve outcomes across the behavioral health continuum. Apply for complimentary registration now.
