Managing OUD in Acute Care Settings-View Presentation Slides

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This presentation reviewed how to identify, assess, treat, prevent, and plan continuing care for opioid use disorder (OUD) in acute care settings such as emergency departments and hospitals. Using a trauma patient case, it highlighted common challenges: missed screening, stigma, mistrust, pain control conflicts, withdrawal concerns, and difficult discharge planning.<br /><br />Key themes included the concentration of substance use disorders in acute care, the need for universal or targeted screening, and the importance of therapeutic alliance. Presenters emphasized avoiding biased language and diagnostic stigma, validating patient concerns, and clearly communicating roles and goals.<br /><br />Assessment focused on distinguishing intoxication, overdose, withdrawal, OUD diagnosis, comorbid psychiatric/medical issues, and social risks affecting discharge. The session reviewed the Clinical Opiate Withdrawal Scale (COWS) and DSM-5 OUD criteria.<br /><br />Treatment guidance covered pain management and medications for OUD (MOUD). For acute pain, multimodal analgesia and, when needed, higher-dose full agonist opioids should not be withheld. MOUD options included:<br />- Standard buprenorphine induction when objective withdrawal is present<br />- Low-dose buprenorphine (“microinduction”) for patients needing ongoing opioid analgesia or unable to tolerate withdrawal<br />- High-dose buprenorphine induction for rapid control in clear withdrawal<br />- Methadone for complex pain or when buprenorphine is not feasible<br /><br />The presentation also addressed fentanyl’s prolonged tissue redistribution, which can make precipitated withdrawal more likely even after waiting. It explained how to respond to precipitated withdrawal and how to manage symptoms like anxiety, nausea, diarrhea, and insomnia.<br /><br />Perioperative guidance recommended continuing buprenorphine rather than stopping it. Prevention strategies included naloxone prescribing, safer-use counseling, wound care, mobility support, and follow-up planning.<br /><br />Finally, the session described discharge linkage options such as office-based buprenorphine, opioid treatment programs, bridge clinics, residential care, and addiction consultation services, stressing that effective hospital-based OUD care requires systems support and coordinated continuing care.
Keywords
opioid use disorder
acute care
emergency department
hospital care
buprenorphine
methadone
withdrawal management
pain management
naloxone
discharge planning