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Author Spotlight: An Efficient Methodology to Confidently Differentiate and Characterize Fentanyl Analogs
Published on: November 8, 2024
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Trends in Buprenorphine and Methadone Initiation for Opioid Use Disorder Among Patients Using Fentanyl: A
Journal of Addiction Medicine
|April 7, 2026
Summary
Methadone initiation for hospitalized patients with opioid use disorder (OUD) increased significantly, driven by concerns over fentanyl contamination and fears of precipitated withdrawal. Early challenges in starting medications for opioid use disorder (MOUD) require optimized stabilization strategies.
Area of Science:
- Addiction Medicine
- Pharmacology
- Public Health
Background:
- Opioid use disorder (OUD) is a significant public health crisis, often requiring medication for opioid use disorder (MOUD) for effective treatment.
- The prevalence of fentanyl has introduced new challenges and complexities in OUD treatment, particularly regarding medication selection and initiation.
- Understanding patient perspectives on MOUD is crucial for optimizing treatment strategies in the context of evolving drug supply.
Purpose of the Study:
- To analyze trends in the initiation of medications for opioid use disorder (MOUD) among hospitalized patients with opioid use disorder (OUD) between 2018 and 2022.
- To explore patient-reported factors influencing the selection of MOUD, considering the increasing prevalence of fentanyl.
- To identify barriers to MOUD initiation and inform strategies for improved patient stabilization.
Main Methods:
- Retrospective mixed-methods study of adult patients with OUD admitted to an urban academic hospital from 2018-2022.
- Evaluation of MOUD selection trends (buprenorphine, methadone, no MOUD) using multivariable logistic regression.
- Qualitative review of 100 medical records to assess patient perspectives on prior MOUD experiences and selection challenges.
Main Results:
- Methadone initiation increased from 14.6% in 2018 to 41.4% in 2022, while buprenorphine rates remained stable.
- Patients admitted in later years were more likely to receive methadone compared to no MOUD.
- Key patient concerns included fear of fentanyl contamination (70%), precipitated withdrawal (38%), and slow methadone titration (63%).
Conclusions:
- Methadone selection has notably increased among hospitalized patients with OUD during the study period.
- Patient-reported barriers, such as fear of precipitated withdrawal and concerns about titration, significantly impact MOUD initiation.
- Optimizing MOUD stabilization strategies is essential to address the challenges posed by fentanyl and improve treatment outcomes.
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