Prescribing Short-acting Full-agonist Opioid Medications to Hospitalized Patients Experiencing Withdrawal

Guidelines support the administration of methadone, buprenorphine, and non-opioid adjuncts for the treatment of opioid withdrawal in hospitalized patients, but this approach may be inadequate in the fentanyl era. Short-acting full-agonist opioids (SAFAO) are another option in this setting. Through retrospective chart review, researchers at a US urban safety net hospital aimed to characterize the administration of SAFAO and pertinent outcomes among adult inpatients with opioid use disorder who received SAFAO between March and June 2023.

• There were 124 hospitalizations among 108 patients; 83 percent had fentanyl use. The mean age was 42; 64 percent were cisgender male, and 62 percent were white.
• Medications for opioid use disorder (MOUD) were started in 94 percent of hospitalizations.
• Twenty-five percent of hospitalizations ended in patient directed discharges (PDD). Patients with PDD were more likely to have at least moderate withdrawal symptoms (i.e., COWS >12*), compared with those with non-PDD discharges (55 percent versus 32 percent, respectively).
• SAFAO were administered in intravenous and oral forms. The most common initial regimen was a combination oral oxycodone and intravenous hydromorphone (88 percent of hospitalizations). The mean oral morphine equivalents during the week were 278 mg with a peak of 409 mg on day six.
• Average daily COWS was inversely correlated with SAFAO oral morphine equivalents (Spearman rank correlation, -0.96).
• There were five adverse events with no deaths.

* Clinical Opioid Withdrawal Scale, which is scored: 5–12 = mild; 13–24 = moderate; 25–36 = moderately severe; >36 = severe withdrawal.

Comments: In this cohort, relatively high doses of SAFAO were required for adequate treatment of opioid withdrawal, supporting the observation that methadone or buprenorphine alone may not be sufficient. Results suggest that, in certain patients, the benefits may outweigh risks for treatment of opioid withdrawal with additional SAFAO, compared with MOUD alone.

Elliott Brady, MD, MPH** & Darius A. Rastegar, MD

** 2024–2025 Rich Saitz Editorial Intern & Addiction Medicine Fellow, Montefiore Einstein Addiction Medicine Fellowship Program

Reference: Steiner G, Suen LW, Martin M, et al. Treatment of inpatient opioid withdrawal with short-acting full agonist opioids at a safety-net hospital. J Gen Intern Med. 2025 [Epub ahead of print]. doi: 10.1007/s11606-024-09321-5.