Release Date
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Language of Resource
Full Text Available
Open Access / OK to Reproduce
Peer Reviewed
Objective
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.
Findings/Key points
The authors present evidence to demonstrate that short-acting opioids can be used to manage inpatients’ pain and OUD withdrawal symptoms. Including harm reduction interventions that are evidence-based—such as naloxone kits, sterile drug use equipment, and supervised consumption—in 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.
Design/methods
The case:
KC is admitted for infective endocarditis due to repeated injection drug use. KC has a long history of opioid use disorder (OUD). 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 before 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.
