What the study found
Hospital-based addiction clinicians reached consensus on several best practices for starting medications for opioid use disorder (MOUD), which are medications used to treat opioid use disorder. They agreed that buprenorphine and methadone initiation were appropriate, while naltrexone initiation was uncertain.
Why the authors say this matters
The authors conclude that these best practices can inform current clinical approaches. They also say the findings reflect the need for more robust research to evaluate effectiveness and safety.
What the researchers tested
The study used a 2-round Delphi process, a structured survey method for building expert agreement, from January to April 2025. National hospital-based clinicians who had treated at least 100 hospitalized patients with opioid use disorder in the prior 2 years and who identified as experts in methadone and buprenorphine initiation rated the appropriateness of specific hospital-based practices using a 9-point scale.
What worked and what didn't
Experts reached consensus that rapid methadone initiation was appropriate. For buprenorphine initiation, high-dose and low-dose initiation were considered appropriate, traditional initiation was of uncertain appropriateness, and rescue was inappropriate. They also agreed that non-MOUD full agonist opioids were appropriate for opioid withdrawal during methadone initiation, as a bridge during buprenorphine initiation, and for patients who declined MOUD.
What to keep in mind
This was a survey study of expert opinion, not a test of clinical outcomes. The abstract does not provide direct evidence on effectiveness or safety, and it does not describe additional limitations beyond the need for more research.
Key points
- Experts agreed that buprenorphine and methadone initiation were appropriate in the hospital.
- Naltrexone initiation was rated as uncertain by the expert panel.
- Rapid methadone initiation was considered appropriate.
- For buprenorphine, high-dose and low-dose initiation were appropriate, traditional initiation was uncertain, and rescue was inappropriate.
- Non-MOUD full agonist opioids were considered appropriate for withdrawal treatment in several hospital scenarios.
Disclosure
- Research title:
- Experts reached consensus on hospital-initiated opioid treatment practices
- Image credit:
- Photo by Engin_Akyurt on Pixabay
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