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Rapid Methadone Induction in a General Hospital Setting: A Retrospective, Observational Analysis.

Sarah Casey1, Susan Regan2, Evan Gale2

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Hospitalization allows for rapid methadone initiation and dose titration in patients with opioid use disorder. This approach was infrequently linked to safety issues and successfully connected most patients to treatment programs.

Keywords:
addiction consult teamfentanylhospitalmethadoneopioid

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Area of Science:

  • Addiction Medicine
  • Pharmacology
  • Public Health

Background:

  • Outpatient methadone guidelines suggest slow dose titration.
  • Increasing fentanyl prevalence and opioid-related mortality necessitate faster therapeutic dosing.
  • Hospitalization offers a controlled environment for methadone initiation, but safety data is limited.

Purpose of the Study:

  • To evaluate methadone dosing practices and safety during inpatient initiation.
  • To assess the rate of connection to opioid treatment programs (OTP) upon discharge.

Main Methods:

  • Retrospective analysis of 112 hospitalized patients initiated on methadone (2016-2022).
  • Examined initial and maximum daily doses, dose escalation timing, and adverse events.
  • Assessed linkage to OTP and methadone-related safety events.

Main Results:

  • Mean initial dose was 32 mg, reaching a mean maximum of 76.8 mg over 5.6 days.
  • 30% experienced safety events, mostly sedation; only 4 were definitely or probably methadone-related.
  • Higher maximum doses (≥100 mg) correlated with increased possibly related events (47.8% vs. 12.4%).
  • 76% were connected to an OTP before discharge.

Conclusions:

  • Rapid methadone dose titration in hospitalized patients is infrequently associated with significant safety events.
  • Inpatient methadone initiation effectively connects patients to community-based treatment.
  • Hospitalization provides a safe setting for optimizing methadone induction.