Leveraging the 72-Hour Rule Change to Support Transition From Hospital to Opioid Treatment Program

Changes have been made to the US federal 72-hour rule, which allows hospitals to administer or dispense but not prescribe up to 72 hours' worth of methadone for opioid withdrawal or opioid use disorder (OUD) at discharge (ie, take-home doses).

To characterize acute care encounters involving take-home methadone and identify variables associated with completion of the transition from hospital to opioid treatment program (OTP) within 72 hours (hereafter 72-hour hospital to OTP linkage).

This cohort study examined hospital and emergency department encounters for patients with OUD who received take-home methadone doses from 4 geographically diverse hospitals between November 2022 and April 2024.

Receipt of take-home methadone at hospital discharge.

The primary outcome was documentation of 72-hour hospital to OTP linkage. Multinomial logistic regression was used to analyze the association between OTP linkage status (yes, no, or unknown) and discharge disposition, OTP enrollment at the time of the acute care encounter, co-use of opioids and stimulants, methadone dose, pregnancy, length of hospital stay, and psychiatric conditions.

Included in the analysis were 519 encounters for 456 individuals (median [IQR] age, 46 [36-56] years) who received take-home methadone at hospital discharge. Of these encounters, 280 (53.9%) involved patients who were male. Weekend discharge was the most common reason for dispensing take-home methadone doses (342 encounters [65.9%]). Overall, 231 encounters (44.5%) involved patients who completed a 72-hour hospital-to-OTP linkage, 67 encounters (12.9%) did not link to an OTP within 72 hours of discharge, and 221 (42.6%) had an unknown 72-hour OTP linkage status. Variables associated with completion of 72-hour hospital to OTP linkage included discharge to a postacute care facility (odds ratio [OR], 2.12; 95% CI, 1.12-4.21; P = .02), OTP enrollment at the time of the acute care encounter (OR, 2.63; 95% CI, 1.48-4.79; P < .001), and increasing methadone dose in 10-mg increments (OR, 1.20; 95% CI, 1.09-1.33; P < .001). Co-use of opioids and stimulants was inversely associated with completion of the 72-hour hospital to OTP linkage (OR, 0.48; 95% CI, 0.26-0.87; P = .01).

In this cohort study, preexisting relationships between hospitals, postacute care facilities, and OTPs, along with provision of take-home methadone, likely facilitated OTP linkage. Expansion of these relationships and processes could facilitate OUD treatment engagement during tenuous care transitions.