Piloting a Hospital-Based Rapid Methadone Initiation Protocol for Fentanyl.

Area of Science:

• Addiction Medicine
• Pharmacology
• Clinical Trials

Background:

• Treating acute opioid withdrawal and opioid use disorder (OUD) is critical.
• Hospitalization presents a key opportunity for rapid methadone initiation for OUD.
• Limited clinical guidance exists for inpatient rapid methadone protocols.

Purpose of the Study:

• To describe the experience with a novel hospital-based rapid methadone initiation protocol for OUD.
• To evaluate the safety and efficacy of rapid methadone induction in an inpatient setting.

Main Methods:

• Retrospective chart review of hospitalized patients with OUD.
• Implementation of a rapid methadone initiation protocol with specific dose recommendations and strict inclusion/exclusion criteria.
• Interprofessional addiction medicine consult service involvement.

Main Results:

• 25 out of 171 patients (15%) initiated methadone via the rapid protocol.
• Average daily methadone doses increased progressively over the first 7 days.
• No adverse events required dose holding, naloxone administration, or transfer to higher care levels.

Conclusions:

• A rapid methadone initiation protocol is feasible in the inpatient setting.
• This protocol enables quicker methadone dose titration than traditional methods.
• Careful patient selection is crucial for safe implementation and to mitigate potential harms.