Management of the Critically Ill Patient with Opioid Use Disorder

The management of critically ill patients with opioid use disorder presents a unique challenge, as overdose, withdrawal, or concomitant intoxication, due to an unregulated drug supply, leads to physiologic changes that potentially impact standard treatment. This review article outlines an emergency medicine-focused approach for early recognition and stabilization of opioid overdose or withdrawal. Topics include naloxone, use of medications for opioid use disorder, recognition of concurrent intoxication, treatment of α2-agonist withdrawal, multimodal analgesia, and sedation for opioid-tolerant patients. The acute management of opioid use disorder is an opportunity to prevent withdrawal-related decompensation, improve comfort, and support ongoing engagement in treatment.