Susan L Calcaterra1, Richard Bottner2, Marlene Martin3, Honora Englander4, Zoe M Weinstein5, Melissa B Weimer6, Eugene Lambert7,8, Matthew V Ronan7,8,9, Sergio Huerta10, Tauheed Zaman11,12, Monish Ullal13, Alyssa F Peterkin5, Kristine Torres-Lockhart14, Megan Buresh15,16, Meghan T O'Brien3, Hannah Snyder17, Shoshana J Herzig7,8,18. 1. Department of Medicine, Division of General Internal Medicine and Division of Hospital Medicine, University of Colorado, Aurora, Colorado, USA. 2. Department of Internal Medicine, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA. 3. Department of Medicine, Division of Hospital Medicine, University of California San Francisco and San Francisco General Hospital, San Francisco, California, USA. 4. Department of Medicine, Section of Addiction Medicine and Division of Hospital Medicine, Oregon Health & Science University, Portland, Oregon, USA. 5. Department of Medicine, Boston Medical Center, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine, Boston, Massachusetts, USA. 6. Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA. 7. Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA. 8. Department of Medicine, Massachusetts General Hospital, Charlestown, Massachusetts, USA. 9. Department of Medicine, VA Boston Healthcare System, West Roxbury, Massachusetts, USA. 10. Department of Internal Medicine, Division of Hospital Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA. 11. San Francisco VA Medical Center, San Francisco, California, USA. 12. Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA. 13. Department of Internal Medicine at Highland Hospital, Alameda Health System, Oakland, California, USA. 14. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA. 15. Division of Addiction Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA. 16. Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA. 17. Family Community Medicine, University of California, San Francisco, San Francisco, California, USA. 18. Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Abstract
BACKGROUND: Hospitalizations related to the consequences of opioid use are rising. National guidelines directing in-hospital opioid use disorder (OUD) management do not exist. OUD treatment guidelines intended for other treatment settings could inform in-hospital OUD management. OBJECTIVE: Evaluate the quality and content of existing guidelines for OUD treatment and management. DATA SOURCES: OVID MEDLINE, PubMed, Ovid PsychINFO, EBSCOhost CINHAL, ERCI Guidelines Trust, websites of relevant societies and advocacy organizations, and selected international search engines. STUDY SELECTION: Guidelines published between January 2010 to June 2020 addressing OUD treatment, opioid withdrawal management, opioid overdose prevention, and care transitions among adults. DATA EXTRACTION: We assessed quality using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. DATA SYNTHESIS: Nineteen guidelines met the selection criteria. Most recommendations were based on observational studies or expert consensus. Guidelines recommended the use of nonstigmatizing language among patients with OUD; to assess patients with unhealthy opioid use for OUD using the Diagnostic Statistical Manual of Diseases-5th Edition criteria; use of methadone or buprenorphine to treat OUD and opioid withdrawal; use of multimodal, nonopioid therapy, and when needed, short-acting opioid analgesics in addition to buprenorphine or methadone, for acute pain management; ensuring linkage to ongoing methadone or buprenorphine treatment; referring patients to psychosocial treatment; and ensuring access to naloxone for opioid overdose reversal. CONCLUSIONS: Included guidelines were informed by studies with various levels of rigor and quality. Future research should systematically study buprenorphine and methadone initiation and titration among people using fentanyl and people with pain, especially during hospitalization.
BACKGROUND: Hospitalizations related to the consequences of opioid use are rising. National guidelines directing in-hospital opioid use disorder (OUD) management do not exist. OUD treatment guidelines intended for other treatment settings could inform in-hospital OUD management. OBJECTIVE: Evaluate the quality and content of existing guidelines for OUD treatment and management. DATA SOURCES: OVID MEDLINE, PubMed, Ovid PsychINFO, EBSCOhost CINHAL, ERCI Guidelines Trust, websites of relevant societies and advocacy organizations, and selected international search engines. STUDY SELECTION: Guidelines published between January 2010 to June 2020 addressing OUD treatment, opioid withdrawal management, opioid overdose prevention, and care transitions among adults. DATA EXTRACTION: We assessed quality using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. DATA SYNTHESIS: Nineteen guidelines met the selection criteria. Most recommendations were based on observational studies or expert consensus. Guidelines recommended the use of nonstigmatizing language among patients with OUD; to assess patients with unhealthy opioid use for OUD using the Diagnostic Statistical Manual of Diseases-5th Edition criteria; use of methadone or buprenorphine to treat OUD and opioid withdrawal; use of multimodal, nonopioid therapy, and when needed, short-acting opioid analgesics in addition to buprenorphine or methadone, for acute pain management; ensuring linkage to ongoing methadone or buprenorphine treatment; referring patients to psychosocial treatment; and ensuring access to naloxone for opioid overdose reversal. CONCLUSIONS: Included guidelines were informed by studies with various levels of rigor and quality. Future research should systematically study buprenorphine and methadone initiation and titration among people using fentanyl and people with pain, especially during hospitalization.
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