Unplanned opioid withdrawal in inpatient settings

Opioid withdrawal commonly presents covertly as withdrawal in a general hospital or mental health acute care setting in patients admitted for other reasons. An opioid may need to be given during admission to prevent further withdrawal symptoms.

Consider starting medication-assisted treatment of opioid dependence (MATOD) (with methadone or buprenorphine) during the admission for patients who develop unplanned withdrawal. Advice from a clinical advisory service is recommended. A comprehensive assessment of opioid and other drug use is essential before starting MATOD. Liaison with community treatment providers is needed during treatment planning if care will be transferred to them. Methadone or buprenorphine doses may sometimes be provided more than once daily (‘splitting’ the dose) in inpatient settings. Comprehensive discharge planning is important to ensure continuous care.

If the patient will only consider short-term treatment, buprenorphine can be used as for treatment of planned opioid withdrawal.

Exercise caution when prescribing buprenorphine with other sedatives, including other opioids, benzodiazepines or gabapentinoids. Observe state and territory statutory health regulations on the prescription of buprenorphine.