Published: 08/20/2026 | Author: Nikki Wisher

A hospital stay may be one of the most underused openings in opioid addiction care. A panel of 42 clinicians has now reached consensus that hospitals should begin medications for opioid use disorder while a patient is still admitted rather than waiting until discharge.

The consensus was published in JAMA Network Open and reported by the University of Florida College of Public Health and Health Professions. The work was driven by a straightforward observation about the drug supply. The opioid crisis has changed, and the guidance built for an earlier phase of it has not kept up.

What Changed in the Drug Supply

Jamie Pomeranz, PhD, a clinical professor of occupational therapy at the University of Florida and a co-author of the study, described the shift plainly. New high-potency synthetic opioids are inexpensive to produce, and even trace amounts are dangerous.

In this phase of the crisis, Pomeranz said, manufacturers are producing more of these drugs, people are taking higher doses, and other substances are being laced with fentanyl and other opioids. The result is a significantly higher risk of overdose.

Lead author Shawn Cohen, MD, an addiction medicine specialist and assistant professor of medicine at Yale University, pointed to newer adulterants entering the supply, including medetomidine, and said people who use drugs are feeling the brunt of the impact.

How the Panel Reached Agreement

The authors used a Delphi method to build consensus among 42 clinicians, many of them board certified in addiction medicine, addiction psychiatry, or both. Pomeranz served as the study’s Delphi consultant, and colleagues at Yale University, Harvard University, and the University of Pittsburgh took part.

The process ran as a multi-round survey. Participants answered questions about addiction treatment practices based on hypothetical patient scenarios. Everyone’s anonymous responses were then shared with the full group, and participants evaluated all responses as the group moved toward agreement.

Pomeranz said the approach avoids a known weakness of focus groups, where participants can be swayed by others in the room. It also makes participation practical for clinicians who are difficult to schedule.

What the Panel Agreed On

The central agreement was on timing. Participating experts concluded it is important to start medications for opioid use disorder among hospitalized patients rather than waiting until they are discharged.

The group also arrived at best practices for several treatment protocols involving methadone and buprenorphine, the two medications most commonly prescribed for opioid use disorder. Research compiled by the National Academies has shown these medications reduce the risk of overdose and death by 50%.

Cohen said the hope is that consensus-backed guidance improves how medications for opioid use disorder are started in hospitals, and that it highlights where more research is needed to clarify the benefits of certain adaptive practices.

Understanding the Medications

Methadone and buprenorphine are both approved by the FDA to treat opioid use disorder. They reduce cravings and blunt withdrawal, which allows someone to stabilize rather than cycling between intoxication and withdrawal.

Naloxone, sold as Narcan, is different. It is an overdose reversal medication, not a treatment. It restores breathing during an opioid overdose and is available without a prescription in every state. Anyone who uses opioids, and anyone close to someone who does, has reason to carry it. Fentanyl test strips can also identify fentanyl in other substances before use.

Why Hospital Timing Matters

A person admitted for an infection, an injury, or an overdose is already in a medical setting with clinicians present. Starting medication during that window means someone leaves the hospital already on treatment rather than leaving with a referral and a gap.

The study authors noted the findings can also serve as a reference for family members or case managers advocating on behalf of a patient with opioid use disorder.

That is a practical point for anyone supporting a loved one. If someone you care about is hospitalized, it is reasonable to ask whether medication for opioid use disorder has been offered before discharge.

The researchers were candid that more robust research is needed to evaluate the effectiveness of different medication initiation strategies. What the study demonstrates is the value of bringing experts together to identify emerging best practices while the drug supply keeps shifting.

Pomeranz also pushed back on a persistent misconception. There is an idea that opioid use disorders affect only certain demographic groups, he said, but the problem has become far more widespread.

Finding Help for Opioid Addiction

If you are leaving a hospital or starting treatment, medication is one part of recovery and peer support is another. Narcotics Anonymous meetings are free, run by people in recovery, and available in person and online across the country.

Many people combine NA meetings with methadone or buprenorphine treatment, and current evidence supports medication for opioid use disorder as effective care. Call 800-934-1582(Sponsored) to speak with a treatment advisor and learn more about your options.