Hospital-Based Methadone and Buprenorphine Initiation Practices by Addiction Consult Services

Area of Science:

• Addiction Medicine
• Clinical Pharmacology
• Public Health

Background:

• High-potency synthetic opioids (HPSOs) complicate treatment initiation for opioid use disorder (OUD).
• Novel hospital-based practices for methadone and buprenorphine initiation have emerged.
• National characterization of these novel practices is lacking.

Purpose of the Study:

• To assess the adoption and nature of novel hospital-based practices for initiating methadone and buprenorphine.
• To understand the perceived impact of HPSOs on these initiation practices.

Main Methods:

• Cross-sectional survey of directors of US hospital-based addiction consult services (ACS).
• Data collected via REDcap anonymous survey from October 2023 to April 2024.
• Practices assessed included standard, rapid methadone initiation, and various buprenorphine initiation strategies (low dose, high dose, traditional, rescue).

Main Results:

• 72.5% of ACS directors completed the survey.
• 81.0% of respondents initiated methadone, with 70.2% reporting HPSOs changed their practices.
• 87.0% reported using rapid methadone initiation, and 93.1% agreed HPSOs impacted buprenorphine initiation.
• All respondents offered buprenorphine initiation, with low-dose being most common, except in cases of significant withdrawal.

Conclusions:

• Hospital-based addiction consult services are adapting methadone and buprenorphine initiation to the evolving synthetic opioid supply.
• Current practices often outpace existing research and clinical guidelines.
• Further research is needed to evaluate the efficacy and safety of these novel initiation strategies.