Utilization of full-agonist therapy for severe precipitated opioid withdrawal: A case series and retrospective analysis

Abstract

Objective: We aim to describe our experience in treating severe precipitated opioid withdrawal with hydromorphone - a short-acting, full opioid agonist - followed by buprenorphine induction.

Methods: This is a retrospective chart review and case series conducted at a single hospital from May 1, 2023 to May 31, 2024 of patients who were seen by a medical toxicology service and received hydromorphone to treat precipitated opioid withdrawal. Descriptive statistics were used to analyze the results as appropriate.

Results: There were 13 patients identified over the study period with severe opioid withdrawal, all suspected to be in precipitated withdrawal (most commonly by buprenorphine). Nearly all patients included in this study had improved withdrawal symptoms after administration of hydromorphone. There was only one patient that did not have adequate improvement with hydromorphone, and this individual required endotracheal intubation and sedation. All patients were discharged with a buprenorphine prescription.

Conclusions: The use of hydromorphone to treat precipitated opioid withdrawal symptoms is feasible and, in our study population, allowed for subsequent buprenorphine induction. Further study is needed to determine safety and efficacy of this approach versus traditional methods.

Keywords: Full opioid agonists; Opioid use disorders; Substance withdrawal syndrome.