Short-Acting Opioid Dose and Patient-Directed Discharge in Hospitalized Patients With Opioid Use Disorder
Alexander Logan1,2, Taylor Baisey1,2, Charles E McCulloch3
1Department of Medicine, University of California, San Francisco.
JAMA Network Open
|June 16, 2026
Summary
Hospitalized patients with opioid use disorder (OUD) receiving higher doses of short-acting opioids experienced less early patient-directed discharge. This suggests short-acting opioids may help reduce early discharges in OUD patients during withdrawal management.
Area of Science:
- Pharmacology
- Addiction Medicine
- Health Services Research
Background:
- Patient-directed discharge is common for hospitalized patients with opioid use disorder (OUD) experiencing withdrawal, often leading to poor outcomes.
- Hospital clinicians increasingly use short-acting opioids with methadone and buprenorphine for OUD withdrawal.
- No studies have examined the link between short-acting opioid use and patient-directed discharge.
Purpose of the Study:
- To investigate the association between short-acting opioid dosing and timing with early patient-directed discharge (within 72 hours) in hospitalized adults with OUD.
Main Methods:
- Retrospective cohort study of adult OUD hospitalizations treated with short-acting opioids.
- Data collected from an urban safety-net hospital's electronic health records.
- Analyzed total daily dose of short-acting opioids (morphine milligram equivalents) and time to first dose, adjusting for covariates.
Main Results:
- Included 669 hospitalizations (520 unique patients); 13.8% resulted in early patient-directed discharge.
- Higher daily doses of short-acting opioids were associated with a reduced hazard of early patient-directed discharge (aHR, 0.92; P=.03).
- No significant association was found between the time to the first dose of short-acting opioids and early patient-directed discharge.
Conclusions:
- Short-acting opioid treatment for opioid withdrawal in hospitalized adults with OUD showed a dose-dependent association with reduced early patient-directed discharge.
- Findings support using short-acting opioids alongside methadone and buprenorphine for inpatient OUD withdrawal management.
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