How Fentanyl and Synthetic Opioids Are Reshaping Opioid Use Disorder Treatment

Fentanyl and other high-potency synthetic opioids (HPSOs) are now the primary factors behind opioid overdose fatalities in the United States. Their prevalence has significantly impacted clinical practices for initiating medications to treat opioid use disorder (OUD). Despite the critical role of FDA-approved treatments such as methadone and buprenorphine, there are currently no standardized protocols tailored for HPSO-sensitive approaches.

A recent study published in JAMA Network Open on August 7, 2025, examined how hospital-based addiction consult services (ACS) are adapting their methods across the country to better serve individuals with OUD amid the evolving drug landscape. The survey of 58 ACS directors revealed a widespread recognition of the challenges posed by HPSOs and an acknowledgment that traditional initiation protocols may no longer be sufficient.

Most clinicians agree that treating patients using HPSOs with methods designed for heroin or prescription opioids may result in inadequate management of withdrawal symptoms, which can cause unnecessary discomfort and potentially poor treatment outcomes. In response, healthcare providers are adopting innovative approaches, such as more rapid methadone initiation and varied buprenorphine protocols, to improve patient care.

Melissa Weimer, MD, from Yale School of Public Health, emphasizes that addressing opioid withdrawal effectively is crucial to prevent complications and enhance recovery prospects. The unique environment of hospitals allows for close monitoring and tailored interventions, making it an ideal setting for trialing new initiation strategies.

Furthermore, experts advocate for community-partnered research to develop timely, evidence-based guidelines that incorporate insights from people with lived experience of drug use. Cohen highlights that engaging affected communities can accelerate improvements in treatment practices, ensuring they are more responsive to ongoing changes in drug supply.

This evolving landscape underscores the necessity for continuous research, flexible clinical practices, and strong collaboration across healthcare systems and communities to effectively combat the overdose crisis and improve outcomes for individuals with OUD.

source: https://medicalxpress.com/news/2025-08-fentanyl-high-potency-synthetic-opioids.html