The efficacy and safety of short-acting, full agonist opioids for symptom management of opioid withdrawal

• Opioid withdrawal syndrome has been observed to be severe in the era of fentanyl and other potent opioids • Undermanaged withdrawal symptoms have been linked to high rates of treatment discontinuation. • Short-acting full-agonist opioids (SAFAOs) have been linked to reduced withdrawal scores and fewer occurrences of treatment discontinuation. • Rigorous studies evaluating effectiveness and safety of SAFAOs are needed. Introduction: Patients with opioid use disorder often have undertreated withdrawal while in hospital, leading to high rates of premature discharges. Short-acting, full agonist opioids (SAFAOs) have been proposed to alleviate withdrawal symptoms when provided as adjuncts to opioid agonist therapy (OAT). We aimed to synthesize evidence on the safety and efficacy of SAFAOs. Methods: We searched the scientific databases MEDLINE, Embase, CINAHL, PsycInfo, Web of Science Core Collection, and the Cochrane Library for studies with adults whose opioid withdrawal symptoms were treated with SAFAOs. Results were narratively synthesized. Results: Our search yielded 5,616 papers screened and 15 studies included. Information was gathered mostly from patient charts, followed by cohort studies, a cross-sectional study, and a clinical trial. Hydromorphone, tramadol, fentanyl, and oxycodone were described individually or as groupings to reduce withdrawal from heroin or fentanyl, initiate OAT, or as a bridge to transition between medications. Most studies observed reduced withdrawal scores and fewer occurrences of premature discharges in those who received these medications. Oversedation was observed as an adverse event in patients with ongoing opioid use. Discussion: This systematic review provides an up-to-date synthesis on the use of SAFAOs to treat withdrawal. Our results suggest that in-hospital use of SAFAOs can reduce patient suffering and potentially the following risk for premature discharges. More clinical studies are needed to further investigate the clinical utility of SAFAO as a combination treatment with OAT.