How Should Risks and Benefits of Short-Acting Opioids Be Evaluated in the Care of Inpatients With OUD?

Severe opioid withdrawal, risk of patient-initiated discharge, and some inpatients' use of unregulated substances prompt clinical and ethical questions considered in this commentary on a case.Short-acting opioids can be used to manage inpatients' pain and opioid use disorder (OUD) withdrawal symptoms.Including evidence-based interventions-such as naloxone kits, substance use equipment, and supervised consumptionin some inpatients' care plans may make those patients safer and reduce their risk of death.These and other strategies align with clinicians' ethical duties to minimize harms and maximize benefits for inpatients with OUD.The American Medical Association designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ available through the AMA Ed Hub TM .Physicians should claim only the credit commensurate with the extent of their participation in the activity.Case KC is admitted for infective endocarditis secondary to microbes entering their bloodstream during repeated injection drug use.KC has a long history of opioid use disorder (OUD) and has intermittently been treated for it.KC's history of using opioids started when KC exhausted a supply of oxycodone, prescribed with limited refills for postoperative pain management, which led KC to start using heroin and then fentanyl.Members of KC's clinical team have not come to consensus about how to manage KC's pain or OUD.They are aware that KC has their own supply of drugs and wants to leave the hospital as soon as possible and against medical advice, if necessary.Team members consider administering short-acting opioids to keep KC comfortable and in hospital for intravenous antibiotics and evaluation for cardiac surgery, but one clinician opposes any care plan that "feeds" KC's OUD. CommentaryPeople who initiate their own discharge from hospital have a well-documented increased risk of death, 1,2 and people who use substances are at greater risk of premature discharge than other groups. 3Every effort must therefore be made to engage people in care that offers concomitant management of their primary medical condition and any