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Fentanyl Withdrawal: Understanding Symptom Severity and Exploring the Role of BMI on Withdrawal Symptoms and Clearance.

BACKGROUND & AIMS
Fentanyl is a highly lipophilic mu opioid receptor agonist increasingly found in heroin and other drug supplies that is contributing to marked increases in opioid-related overdose and may be complicating treatment of opioid use disorder (OUD). This study aimed to measure the influence of body mass index (BMI) on fentanyl withdrawal and clearance.


DESIGN, SETTING, PARTICIPANTS
This secondary analysis, from a 10-day inpatient study on the safety and efficacy of sublingual dexmedetomidine for opioid withdrawal, includes participants with OUD (n=150) recruited from three sites in New York, New Jersey, and Florida, who were maintained on oral morphine (30mg four times per day) for 5 days before starting study medication. Most participants (n=118) tested positive for fentanyl on admission to the inpatient unit.


MEASUREMENTS
Urine toxicology and opioid withdrawal symptoms (Clinical Opioid Withdrawal Scale [COWS] and Short Opiate Withdrawal Scale [SOWS]) were assessed daily. The present analysis includes data on opioid withdrawal from days 1-5 of stabilization, and urine toxicology data from days 1-10.


FINDINGS
Fentanyl status at admission was not significantly associated with COWS or SOWS scores after adjusting for sex, site, and polysubstance use. Participants classified as overweight or obese (n= 66) had significantly higher odds of testing positive for fentanyl across days 1-10 (odds ratio [OR]: 1.65; p < .01) and higher SOWS maximum scores across morphine stabilization (p < .05) compared to those with a healthy BMI (n=68).


CONCLUSIONS
Among inpatients with opioid use disorder, fentanyl status does not appear to be statistically significantly associated with Clinical Opioid Withdrawal Scale and Short Opiate Withdrawal Scale (SOWS) mean and maximum scores. High body mass index (BMI) status (overweight or obese) appears to be an important predictor of slower fentanyl clearance and higher SOWS maximum scores across the inpatient period than lower BMI status.