Utilizing the "72-Hour Rule" to Expand Rapid, Higher Dose Initiation of Methadone in a Hospital-Based Bridge Clinic

Utilizing the 72-hour rule to initiate methadone in low-threshold Bridge Clinics offers a novel way to rapidly start treatment. Recent updates to federal methadone regulations allow for higher starting doses. This study evaluates the implementation of methadone initiation in a Bridge Clinic utilizing higher doses of methadone based on updates to 42CFR part 8.

We identified patients newly initiating methadone in an urban Bridge Clinic in Boston, MA, USA with an intention of connecting to an Opioid Treatment Program (OTP) and extracted key clinical outcomes from the electronic health record, including average initial and final dose and rates of successful referral to an OTP.

Between April 1, 2024 and March 1, 2025, there were 97 patients who received 1 or more doses of methadone at the Bridge Clinic and were confirmed on chart review to have been newly initiated on methadone with the intent of linking to an OTP. Twenty-three point seven percent of patients initiated methadone twice during the study period. The mean starting dose was 51.6 mg, increasing to 60.9 and 67.1 mg at the second and third doses, respectively. Of the 97 patients, 94 (96.9%) were referred and accepted at an OTP.

Initiating methadone under the 72-hour rule in a low-threshold Bridge Clinic setting utilizing higher doses was feasible and resulted in a majority of patients being accepted to an OTP for ongoing treatment.