Workshop: Injectable Opioid Agonist Treatment (iOAT) and Short Acting Opioid Strategies for Fentanyl Use: Bridging International Strategies with Practical Implementation in the USA-Injectable Opioid Agonist Treatment (iOAT) and Short Acting Opioid Strategies for Fentanyl Use: Bridging International Strategies with Practical Implementation in the USA

Injectable Opioid Agonist Treatment (iOAT) and Short Acting Opioid Strategies for Fentanyl Use: Bridging International Strategies with Practical Implementation in the USA

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In a recent discussion, a group of experts explored the potential of injectable opioid agonist treatment (IOT) for opioid use disorder, focusing on strategies used in Canada that may offer new approaches in the US. Dr. Jeremy Welloff, Dr. Julian Raffoul, and Dr. Emily Casey highlighted the use of intravenous (IV) hydromorphone and diacetylmorphine, contrasting these approaches with the US system, which lacks such options due to regulatory hurdles.<br /><br />IOT, or heroin-assisted treatment, has historical roots and substantial evidence from international studies supporting its efficacy, particularly for patients who struggle with traditional treatments like methadone or buprenorphine. The Canadian model demonstrates increased retention in treatment and reduced illicit drug use, although safety risks such as increased overdose rates are noted.<br /><br />Dr. Casey emphasized the practical application of these methods within hospital settings at the University of Pennsylvania, using patient-controlled analgesia and novel induction methods to stabilize patients suffering from withdrawal. The approach aims to keep patients in treatment longer, thereby improving outcomes.<br /><br />Dr. Raffoul shared experiences from Vanderbilt, where IV hydromorphone bridges were used to manage severe withdrawal symptoms effectively, sometimes leading to high-dose buprenorphine inductions. This method prioritizes patient stabilization and engagement in treatment to prevent withdrawal-driven relapse.<br /><br />The panel concluded that despite existing regulatory challenges in the US, the Canadian model provides valuable insights. The history of opioid treatment in the US, influenced by the Harrison Narcotics Act, continues to impact current practices, highlighting the need for evolving strategies to manage opioid use disorder effectively.

Keywords

injectable opioid agonist treatment

IOT

opioid use disorder

Canada

IV hydromorphone

diacetylmorphine

regulatory hurdles

heroin-assisted treatment

treatment retention

withdrawal management

patient stabilization

Harrison Narcotics Act

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