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RAMP-UP: Pharmacist-Led Methadone Titration for Hospitalized Patients With Opioid Use Disorder.

Emily R Casey1, Tanya Uritsky1, Liana Soyfer2

  • 1Department of Pharmacy Services, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.

Substance Use & Addiction Journal
|April 18, 2026
PubMed
Summary
This summary is machine-generated.

A pharmacist-led protocol (RAMP-UP) accelerated methadone titration for opioid use disorder (OUD) in hospitals. While not significantly increasing the proportion reaching a therapeutic dose, it improved speed and safety.

Keywords:
medication for opioid use disorderopioid use disorderpharmacist

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Area of Science:

  • Pharmacology
  • Clinical Pharmacy
  • Addiction Medicine

Background:

  • Hospitals are increasingly initiating methadone treatment for opioid use disorder (OUD).
  • Many hospitals lack specialized addiction consult teams for rapid methadone titration.
  • A pharmacist-led protocol was developed to address this gap.

Purpose of the Study:

  • To evaluate the effectiveness of a pharmacist-led rapid methadone titration protocol (RAMP-UP).
  • To determine if RAMP-UP increased the proportion of hospitalizations reaching a minimally therapeutic methadone dose (≥60 mg) by discharge.
  • To assess secondary outcomes including time to therapeutic dose, total daily dose, and safety events.

Main Methods:

  • A retrospective, quasi-experimental, pre-post study design was employed.
  • Data were collected from adult patients newly initiating methadone for OUD at an academic medical center.
  • Multivariable regression with generalized estimating equations analyzed outcomes before and after RAMP-UP implementation.

Main Results:

  • A higher proportion of post-intervention encounters reached ≥60 mg total daily dose (TDD) of methadone (60.0% vs 45.5%), though not statistically significant in adjusted analyses (P=.06).
  • Post-implementation encounters had a higher methadone TDD at discharge (62 mg vs 55 mg; P=.04).
  • Among those reaching 60 mg TDD, the dose was achieved significantly faster post-implementation (4.0 days vs 9.0 days; P<.001).
  • Opioid-related safety events were infrequent and similar between groups (12.7% vs 11.0%; P=.80).

Conclusions:

  • Pharmacist-guided rapid methadone titration accelerated the attainment of therapeutic doses for hospitalized patients with OUD.
  • The RAMP-UP protocol did not increase adverse events.
  • Inpatient clinical pharmacists can modernize OUD care through protocols like RAMP-UP.