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Treatment
Î Patients on methadone for the treatment of OUD and who are admitted
for surgery may require additional short-acting opioid pain relievers.
• The dose of pain relievers prescribed may be higher due to tolerance.
Î Temporarily increasing buprenorphine dosing may be effective for
mild acute pain.
Î For severe acute pain, discontinuing buprenorphine and commencing
on a high potency opioid (such as fentanyl) is advisable.
• Monitor patients closely and consider additional interventions such as regional
anesthesia.
Î The decision to discontinue buprenorphine prior to an elective surgery
should be made in consultation with the attending surgeon and
anesthesiologist.
• If it is decided that buprenorphine should be discontinued prior to surgery, this
should occur 24–36 hours in advance of surgery and restarted post-operatively
when the need for full opioid agonist analgesia has passed.
Î Patients on naltrexone will not respond to opioid analgesics in the
usual manner. Therefore, it is recommended that mild pain be treated
with NSAIDs and moderate to severe pain be treated with ketorolac on
a short-term basis.
Î Oral naltrexone should be discontinued 72 hours prior to surgery
and extended-release injectable naltrexone should be discontinued
30 days prior to an anticipated surgery.
Adolescents
Î Clinicians should consider treating adolescents who have OUD using
the full range of treatment options, including pharmacotherapy.
Î Opioid agonists (methadone and buprenorphine) and antagonists
(naltrexone) may be considered for treatment of OUD in adolescents.
• Age is a consideration in treatment, and federal laws and FDA approvals need to
be considered for patients under age 18.
Î Psychosocial treatment is recommended in the treatment of
adolescents with OUD.
Î Concurrent practices to reduce infection (e.g., sexual risk reduction
interventions), are recommended as components of comprehensive
treatment for the prevention of sexually transmitted infections and
blood-borne viruses.
Î Adolescents may benefit from treatment in specialized treatment
facilities that provide multidimensional services.
