Case report: acute care management of severe opioid withdrawal with IV fentanyl

• Published in: Addiction science & clinical practice Vol. 17; no. 1; p. 22
• Main Authors: Azar, Pouya, Westenberg, Jean N, Ignaszewski, Martha J, Wong, James S H, Isac, George, Mathew, Nickie, Krausz, R Michael
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 05.04.2022; BioMed Central; BMC
• Subjects: Acute care; Acute services; Analgesics, Opioid - adverse effects; Anesthesia; Antibiotics; Care and treatment; Case reports; Case Study; Cellulitis; Comorbidity; Drug dosages; Drug withdrawal; Fentanyl; Fentanyl - adverse effects; Health aspects; Health care management; Health status; Heroin; Hospital patients; Hospitalization; Humans; Medical treatment; Methamphetamine; Methicillin; Morphine; Narcotics; Narcotics - therapeutic use; Opioid use disorder; Opioid-Related Disorders - drug therapy; Opioids; Pain; Pain management; Patient centered care; Preferences; Research Report; Severity; Staphylococcus infections; Substance abuse; Substance use disorder; Treatment needs; Type 2 diabetes; Withdrawal management; North America; Canada; Pain management; Fentanyl; Inpatient; Withdrawal management; Opioid use disorder; Patient centered care; Acute care
• ISSN: 1940-0640; 1940-0632; 1940-0640
• DOI: 10.1186/s13722-022-00305-6

An increasing number of individuals who use drugs in North America are preferentially consuming fentanyl over other opioids. This has significant consequences on the treatment and management of opioid use disorder (OUD) and its concurrent disorders, especially in acute care if opioid requirements are not met. We present a patient with severe OUD and daily injection of fentanyl, admitted to hospital for management of acute physical health issues. Due to high opioid requirements and history of patient-initiated discharge, intravenous fentanyl was administered for treatment of opioid withdrawal, and management of pain, which supported continued hospitalization for acute care treatment and aligned with substance use treatment goals. This case demonstrates that intravenous fentanyl for management of OUD in hospital can be a feasible approach to meet opioid requirements and avoid fentanyl withdrawal among patients with severe OUD and daily fentanyl use, thereby promoting adherence to medical treatment and reducing the risk of patient-initiated discharge. There is an urgent need to tailor current treatment strategies for individuals who primarily use fentanyl. Carefully designed research is needed to further explore the use of IV fentanyl for acute care management of severe opioid withdrawal in a hospital setting.