A retrospective cohort study of a novel short-acting opioid protocol for opioid withdrawal.

BACKGROUND: Hospitalized patients with opioid use disorder commonly experience undertreated withdrawal, leading to increases in patient-directed discharge and readmission. Short-acting opioids can mitigate withdrawal in patients who are unwilling to trial buprenorphine or methadone, or need additional symptom control during up-titration. OBJECTIVES: This study assessed the safety and efficacy of a short-acting opioid protocol for opioid withdrawal. METHODS: A retrospective cohort study was conducted on hospitalized patients with opioid use disorder who received a short-acting opioid protocol for withdrawal with intravenous hydromorphone or oral oxycodone. The primary endpoint was the incidence of severe withdrawal. Secondary endpoints included naloxone use, patient-directed discharge, and length of stay. A paired cohort was analyzed where patients' hospital outcomes were compared pre- versus post-protocol. RESULTS: Naloxone use after protocol initiation was 0% and severe withdrawal occurred in one patient (1%). The patient-directed discharge and 30-day readmission rates were 38% and 30%, respectively. Fifty-one percent of patients had a prior hospitalization within two years without use of the short-acting opioid protocol and were included in the paired cohort analysis. The pre- versus post-protocol patient-directed discharge rate was 47% vs. 43% (p = 0.774) and length of stay was 3 vs. 5 days (p = 0.180). CONCLUSIONS: Our findings provide preliminary evidence for the safety of a short-acting opioid protocol for opioid withdrawal. There was no significant difference in patient-directed discharge rate or length of stay in the paired cohort of patients' encounters with or without short-acting opioid protocol use. Larger studies are necessary to draw conclusions regarding safety and efficacy.