{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T16:03:13Z","timestamp":1781625793232,"version":"3.54.5"},"reference-count":33,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Patient-directed discharge, common among hospitalized patients with opioid use disorder (OUD) experiencing opioid withdrawal, is associated with poor outcomes. Increasingly, hospital-based clinicians are using short-acting opioids alongside methadone and buprenorphine to treat opioid withdrawal. However, no published studies have examined the association between this practice and patient-directed discharge.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To examine associations between dosing of short-acting opioids and time to first dose of short-acting opioid with early patient-directed discharge (within 72 hours).<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This retrospective cohort study included hospitalizations involving adults with OUD who were treated with short-acting opioids between February 7 and December 31, 2024, using an opioid withdrawal order set in the electronic health record at an urban safety-net hospital. Statistical analysis was conducted between October 2024 and October 2025.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Total daily dose of short-acting opioids (oxycodone and hydromorphone) expressed in morphine milligram equivalents, and time from emergency department intake to first dose of short-acting opioid.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was early patient-directed discharge, adjusted for age, race and ethnicity, gender, other substance use disorder, receipt of medications for OUD, and addiction care team consultation.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 669 hospitalizations, representing 520 unique patients, were included. Patients were a mean (SD) age of 44.1 (12.2) years, with most identifying as male (531 of 669 [79.4%], with 122 of 669 female [18.2%] and 16 of 669 gender minority [2.4%]) and unhoused (555 of 669 [83.0%]). A total of 92 hospitalizations (13.8%) resulted in early patient-directed discharge. In the final adjusted model, each doubling of the patient\u2019s daily dose of short-acting opioids was associated with an 8% reduction in the hazard of early patient-directed discharge (adjusted hazard ratio, 0.92 [95% CI, 0.86-0.99];\n P<\/jats:italic>\n \u2009=\u2009.03). There was no statistically significant association between time to first dose of short-acting opioid and patient-directed discharge within 72 hours.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study of hospitalized adults with OUD, treatment of opioid withdrawal with short-acting opioids exhibited a dose-dependent association with reduced hazard of early patient-directed discharge. These findings support the use of short-acting opioids alongside methadone and buprenorphine for inpatient treatment of opioid withdrawal.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.18698","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T15:00:20Z","timestamp":1781622020000},"page":"e2618698","source":"Crossref","is-referenced-by-count":0,"title":["Short-Acting Opioid Dose and Patient-Directed Discharge in Hospitalized Patients With Opioid Use Disorder"],"prefix":"10.1001","volume":"9","author":[{"given":"Alexander","family":"Logan","sequence":"first","affiliation":[{"name":"Department of Medicine, University of California, San Francisco"},{"name":"San Francisco General Hospital, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taylor","family":"Baisey","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California, San Francisco"},{"name":"San Francisco 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