Critical care clinicians are likely to see an increasing number of patients admitted to the intensive care unit (ICU) who are receiving FDA-approved medications for opioid use disorder (MOUD) given the well-documented benefits of these agents. Oral methadone, multiple formulations of buprenorphine, and extended-release naltrexone are the three types of MOUD most likely to be encountered by ICU clinicians; however, these formulations vary with respect to formulations, pharmacokinetics, and adverse effects.
No published clinical practice guidelines or consensus statements are available to guide decision making in patients admitted to the ICU setting who were receiving MOUD prior to admission. Additionally, there are no randomized trials and limited observational studies evaluating issues related to MOUD use in the ICU. Therefore, ICU clinicians caring for patients admitted on MOUD must base their decision making on data extrapolation from pharmacokinetic, pharmacologic, and clinical studies performed in non-ICU settings.

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