Methadone Initiation in the Emergency Department for Opioid Use Disorder.

Area of Science:

• Addiction Medicine
• Emergency Medicine
• Pharmacology

Background:

• Rising overdose deaths from synthetic opioids like fentanyl necessitate effective treatments for opioid use disorder (OUD).
• Emergency departments (EDs) increasingly offer medication for opioid use disorder (MOUD), primarily buprenorphine.
• Buprenorphine initiation carries a risk of precipitated withdrawal due to fentanyl accumulation in adipose tissue, unlike methadone.

Purpose of the Study:

• To describe the implementation of an ED-initiated methadone treatment pathway for OUD.
• To compare 72-hour outpatient treatment engagement rates between ED-initiated methadone and buprenorphine pathways.

Main Methods:

• An ED MOUD program was expanded to include a methadone pathway alongside the existing buprenorphine pathway.
• Patients with OUD were enrolled (28 in methadone, 33 in buprenorphine) after screening 20,504 ED arrivals.
• Methadone patients received initial doses in the ED and were dispensed additional doses for observed daily dosing until transfer to an opioid treatment program (OTP).

Main Results:

• Outpatient treatment engagement within 72 hours was observed in 43% of patients in the methadone pathway (12/28).
• Outpatient treatment engagement within 72 hours was observed in 45% of patients in the buprenorphine pathway (15/33).
• The relative risk for engagement was 1.06 (95% CI 0.60-1.87), indicating similar outcomes between the two MOUD pathways.

Conclusions:

• ED-initiated methadone treatment for OUD demonstrates comparable 72-hour outpatient follow-up engagement rates to ED-initiated buprenorphine.
• This study validates methadone as another viable MOUD option that can be initiated in the emergency department setting.
• Expanding MOUD options in the ED can improve access to life-saving treatment for individuals with opioid use disorder.