Pain or Opioid Withdrawal in Hospitalized Patients

Patients with OUD have substantial opioid tolerance and require higher doses of opioids for effective analgesia compared to opioid-naïve patients. This is particularly true in the era of fentanyl; experts in Philadelphia estimate that a single bag of “dope” is equivalent to approximately 300 mg of oxycodone. Please note that the drug supply varies between different cities and regions and that this estimate is applicable only to the Philadelphia area.


We have written a protocol to provide evidence-based, safe, and compassionate treatment of pain and opioid withdrawal for hospitalized and emergency department patients with active OUD. Our approach is to treat pain and withdrawal with a combination of methadone or buprenorphine, short-acting opioids, and non-opioid adjuvants.


Clinicians working within UPHS can access the protocol in pathway format directly through PennPathways.

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Our protocol is also available in a downloadable PDF format below: