A new study published in JAMA Network Open on May 7, 2026, has developed best practices for hospital-initiated medications for opioid use disorder (MOUD) through a consensus-building process with 42 national experts in hospital-based addiction treatment.
According to the study, hospitalization offers a critical opportunity for individuals with opioid use disorder to begin treatment with evidence-based medications, such as buprenorphine and methadone.
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However, clinicians have faced challenges initiating treatment with these medications in patients who are using fentanyl and other high-potency synthetic opioids (HPSOs), which are orders of magnitude more potent than other opioids.
Shawn Cohen, MD, assistant professor of medicine at Yale School of Medicine and lead author of the study, explains that HPSOs can complicate treatment due to their unique properties.
Clinicians across the country are implementing novel initiation strategies and other measures to improve patient experience and outcomes, but often with limited evidence at their disposal.
The study aimed to identify best practices for MOUD initiation in the hospital via a consensus-building process called the Delphi method, which involved reviewing adaptation in how clinicians are starting methadone and buprenorphine, as well as utilization of other medications to treat withdrawal.
The researchers presented participants with hypothetical patient cases where starting MOUD may be indicated and asked them to rate the appropriateness of specific clinical practices on a scale ranging from very appropriate to very inappropriate.
Broad consensus was achieved on the appropriateness of several adaptations in the treatment of patients using HPSOs, signaling practice changes that are actively becoming standard of care.
Cohen notes that the consensus highlights that experts believe the adaptations work and improve care for hospitalized patients with OUD.
While clinicians continue to innovate at the bedside to deliver the best possible care for their patients, researchers have an opportunity to strengthen the supporting science, according to Melissa Weimer, DO, MCR, associate professor of medicine and public health at Yale School of Medicine and Yale School of Public Health.
The authors call for clear communication and shared decision-making with patients, as well as further investment in community-based participatory research centering the perspectives of people who use drugs on how best to meet the challenges posed by HPSOs.
The study’s findings have been published in JAMA Network Open, with the DOI number 10.1001/jamanetworkopen.2026.11514.
In a room on the Yale University campus, the researchers spent hours discussing the implications of their study, which was conducted over several months.
The study’s results are expected to inform hospital-based addiction treatment practices and highlight areas where more research is needed to clarify the benefits of certain adaptive practices.
Expert Consensus on MOUD Initiation
Expert consensus supports adaptations in hospital-initiated medications for opioid use disorder, including rapid methadone initiation, high- and low-dose buprenorphine protocols, adjunctive withdrawal management, and use of long-acting injectables, particularly for patients using high-potency synthetic opioids.
These practices are becoming standard despite limited rigorous evidence, highlighting the need for further research, according to the study’s authors.
The researchers hope that their study will help improve MOUD initiation practices in the hospital and highlight areas where more research is needed to clarify the benefits of certain adaptive practices.
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