*Purpose: The opioid epidemic has raised the question of how transplant teams should work with patients who are prescribed opioids. Benzodiazepine use has also received increased attention, as more than 30 percent of overdoses involving opioids also include benzodiazepines. Pre-transplant opioid use has been associated with increased risk of graft loss and both opioids and benzodiazepines are associated with a higher risk for mortality. However, there is no consensus or uniformity of practice regarding these issues when determining candidacy for lung transplant. Centers must determine how to evaluate patients for transplant with opioid, opioid substitution therapy (e.g. methadone or suboxone), or benzodiazepine use. This survey of lung transplant centers sought to identify existing policies and practices regarding use of opioids, opioid substitution therapy (OST), and benzodiazepines in adult lung transplant candidates.

*Methods: Recruitment was done via an online survey posted on the American Society of Transplantation (AST) community of practice listservs. Transplant centers that did not respond to the AST post were contacted by email. Descriptive statistics were used.

*Results: Of 64 adult lung transplant centers, 34 (53.1%) responded. Most respondents were pulmonologists (41.7%) or psychologists (25.0%). There were four centers that considered opioid use an absolute contradiction (11.8%), while 82.4% considered it a relative contraindication. Regarding OST use, seven centers (20.6%) considered it an absolute contraindication and 58.8% considered it a relative contraindication. Only three centers considered benzodiazepine use an absolute contradiction (8.8%), while 64.7% considered it a relative contraindication. There was a range of evaluation practices with considerable variability across centers. Most centers did not have written policies. Centers were most likely to have a written policy regarding opioid use (32.4%), and the majority of centers did not have written policies regarding OST or benzodiazepine use (79.4% and 70.6%, respectively). Over half of respondents (61.8%) believed that a national consensus policy is needed to address opioid and OST use in lung transplant candidates.

*Conclusions: Survey results highlight the range of policies and practices within the lung transplant community regarding opioid, OST, and benzodiazepine use, as well as the opportunity to develop a national consensus statement regarding these topics.

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