ArticleJAMA network open2026
Short-Acting Opioid Dose and Patient-Directed Discharge in Hospitalized Patients With Opioid Use Disorder.
Article in JAMA network open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Importance: Patient-directed discharge, common among hospitalized patients with opioid use disorder (OUD) experiencing opioid withdrawal, is associated with poor outcomes. Increasingly, hospital-based clinicians are using short-acting opioids alongside methadone and buprenorphine to treat opioid withdrawal. However, no published studies have examined the association between this practice and patient-directed discharge. Objective: To examine associations between dosing of short-acting opioids and time to first dose of short-acting opioid with early patient-directed discharge (within 72 hours). Design, Setting, and Participants: This retrospective cohort study included hospitalizations involving adults with OUD who were treated with short-acting opioids between February 7 and December 31, 2024, using an opioid withdrawal order set in the electronic health record at an urban safety-net hospital. Statistical analysis was conducted between October 2024 and October 2025. Exposures: Total daily dose of short-acting opioids (oxycodone and hydromorphone) expressed in morphine milligram equivalents, and time from emergency department intake to first dose of short-acting opioid. Main Outcomes and Measures: The primary outcome was early patient-directed discharge, adjusted for age, race and ethnicity, gender, other substance use disorder, receipt of medications for OUD, and addiction care team consultation. Results: A total of 669 hospitalizations, representing 520 unique patients, were included. Patients were a mean (SD) age of 44.1 (12.2) years, with most identifying as male (531 of 669 [79.4%], with 122 of 669 female [18.2%] and 16 of 669 gender minority [2.4%]) and unhoused (555 of 669 [83.0%]). A total of 92 hospitalizations (13.8%) resulted in early patient-directed discharge. In the final adjusted model, each doubling of the patient's daily dose of short-acting opioids was associated with an 8% reduction in the hazard of early patient-directed discharge (adjusted hazard ratio, 0.92 [95% CI, 0.86-0.99]; P = .03). There was no statistically significant association between time to first dose of short-acting opioid and patient-directed discharge within 72 hours. Conclusions and Relevance: In this cohort study of hospitalized adults with OUD, treatment of opioid withdrawal with short-acting opioids exhibited a dose-dependent association with reduced hazard of early patient-directed discharge. These findings support the use of short-acting opioids alongside methadone and buprenorphine for inpatient treatment of opioid withdrawal.
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