Reichheld AM, et al. - Via a survey of intensive care unit (ICU) clinicians in the United States, researchers assessed the availability of protocols and guidelines in ICUs for the management of critically ill patients with opioid use disorder. Overall 300 hospitals were contacted, 118 consented to participate, and 58 submitted surveys (49%, 58/118 response rate). They found that a guideline to titrate sedative analgesics was available in a majority of ICUs but a guideline that addresses the sedation requirements of patients with opioid use disorder was reported by only 7%. For managing opioid withdrawal or for avoiding over-reversal with naloxone, most respondents reported either an absence of or were unaware of a guideline. In order to avoid harm and improve recovery for this expanding and vulnerable ICU population, the tools necessary for clinicians need to be offered by more institutional guidelines.