As the opioid epidemic continues, the prevalence of opioid use disorder (OUD) among hospitalized patients continues to rise. There is a major gap between OUD prevalence and the number of patients receiving medication access. The hospital setting offers clinicians a great and timely opportunity to engage and initiate management of OUD. The DEA recently announced the elimination of the DATA-Waiver program which will expand access to treatment for many patients. The current standards of care for OUD and opioid withdrawal include μ-opioid receptor agonists, (e.g., methadone), partial agonists (e.g., buprenorphine), μ-opioid receptor antagonists (e.g., naltrexone) and α2-adrenergic receptor agonists (e.g., clonidine and lofexidine). Newer agents also make use of these pharmacological mechanisms, including tramadol (μ-opioid receptor agonism) and tizanidine (α2 agonism). There are several ancillary medications that are also used in the management of opioid withdrawal. The goal of this presentation is to offer a practical guide to the management of OUD and opioid withdrawal in the consult setting.

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TRANSCRIPT
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