Hospital-Based Methadone and Buprenorphine Initiation Practices by Addiction Consult Services

How commonly are hospital-based addiction clinicians using novel methadone and buprenorphine initiation practices to address challenges brought by fentanyl and high-potency synthetic opioid use?In this national, cross-sectional survey study of 58 addiction fellowship–associated hospital consult service directors, practices including rapid methadone initiation, use of full-agonist opioids for opioid withdrawal, and use of low- and high-dose buprenorphine initiation were widespread.These findings suggest that among hospital-based academic addiction consult directors, methadone and buprenorphine initiation in the hospital setting is adapting to a shifting opioid supply, often outpacing advances in research and clinical guidelines.

Corresponding Author: Shawn M. Cohen, MD, Program in Addiction Medicine, Yale School of Medicine, 367 Cedar St, Harkness Hall A, Ste 417A, New Haven, CT 06510 (shawn.cohen@yale.edu).

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