Amidst the surge of opioid-related overdoses in the United States, the field of opioid use disorder (OUD) treatment has seen few novel treatments emerge. High-potency synthetic opioids (HPSOs) have significantly altered clinical approaches, prompting a reevaluation of the effectiveness of existing medications for opioid use disorder (MOUD) and sparking interest in international treatments for OUD which include injectable opioid agonist treatment (iOAT) and slow-release oral morphine (SROM) as therapeutic options. Embracing OUD prescribing practices aligned with growing international consensus may constitute an integral part of a larger, multi-pronged strategy to combat the opioid crisis in the USA more effectively.

Here we provide an update on iOAT and other short acting opioids that have become standards in guideline-based care in Canada for the stabilization of severe OUD, useful tools for bridging to buprenorphine, and as third- or fourth- line options for the treatment of OUD. In addition, this workshop also covers the policy and legislative issues in the USA concerning the use of these medications as well as the historical context and long-standing effects of the Harrison Narcotics Act of 1914 (and subsequent federal regulations), which constrict the range of opioid agonist medications permitted for OUD treatment. We then provide American examples of the implementation of short acting opioids within various treatment settings and populations, including pregnant women. This workshop finishes by laying out a framework for next regulatory, policy, and research steps that may contribute to FDA regulatory decisions around these medications in the USA.

• Participants will be able to describe international strategies using different formulations of iOAT (hydromorphone and diacetylmorphine) and slow-release oral morphine (SROM) for severe opioid use disorder.
• Participants will be able to demonstrate knowledge about the use of short acting opioid strategies during methadone inductions, switches to buprenorphine, and as monotherapy for severe opioid use disorder.
• Participants will be able to describe the regulatory and policy issues that impact the use of these of these medications in the USA and will be able to employ these strategies within the hospital setting guided by contemporary literature.

• Opioid Use Disorder
• Injectable Opioid Agonist Treatment (iOAT)
• Slow-Release Oral Morphine (SROM)

Jeremy Weleff, DO, Chairperson

       

Dr. Jeremy Weleff is an Instructor and Public Psychiatry Fellow at Yale University School of Medicine. He will soon (July 2024) be Assistant Professor at the University of Alberta and Assistant Professor (Adjunct) at Yale School of Medicine. He completed psychiatry residency training at the Cleveland Clinic and completed both Addiction Psychiatry Fellowship and Public Psychiatry Fellowship at the Yale School of Medicine. 

Julian Raffoul, MD, PhD, Presenter

   

Dr. Julian Raffoul is an IM trained M.D./Ph.D. from Wayne State University, Detroit, MI and former post-doctoral research fellow in molecular therapeutics at the Karmanos Cancer Institute, Detroit, MI.

He recently completed a general psychiatry residency and addiction psychiatry fellowship at Vanderbilt University Medical Center, Nashville, TN and is currently a clinical fellow in consultation-liaison psychiatry in the Division of Medical Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA.   

Emily Casey, MD, Presenter

         

Emily Casey is a Clinical Pharmacy Specialist in Pain Management and Substance Use Disorders. She practices at the University of Pennsylvania Health System in Philadelphia, Pennsylvania.