Because opioid withdrawal syndrome, while averse is not deadly, many insurers will not pay for hospitalization for treatment of opioid withdrawal. Partly for this reason, opiate withdrawal is generally managed in the outpatient setting in methadone treatment facilities (or in licensed opioid agonist therapy [OAT] programs).
Occasionally, patients like this one are admitted to a nonmethadone facility (e.g., hospital) for another illness, and opioid dependence treatment using opioids is necessary to help treat the primary illness (e.g., an acute myocardial infarction in a patient with heroin withdrawal). Management of opioid withdrawal in these patients can be difficult.
The primary concern should be managing the acute medical illness and stabilizing the patient undergoing opioid withdrawal. In the case of a patient with an acute illness and opioid withdrawal (like the patient who presented in our case) who does not want long-term treatment for their opioid dependence, a short, tapering “detoxification” course of opioids is often used.
In both outpatient and inpatient settings, both methadone and Buprenorphine can be used to treat opioid withdrawal as well as to provide longer term maintenance treatment for opiate dependence.
Emerging evidence suggests that a short, decreasing dose course of either methadone or Buprenorphine can ameliorate the symptoms of withdrawal while acute medical issues are addressed. Doses used depend on several factors including the patient’s level of physical opioid dependence, the type of opioids illicitly used, and the nature of the acute medical illness.
Typically, detoxification treatment lasts less than 2 weeks, and there are several protocols available and studied. Emerging research has also outlined detoxification protocols using Buprenorphine and its potential preferential benefits as a first-line pharmacologic agent.
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