Overcoming Legislative and Institutional Barriers to Implementing Methadone Dispensing in a California Health System.

Area of Science:

• Public Health
• Health Policy
• Addiction Medicine

Background:

• Opioid overdose deaths surged during the COVID-19 pandemic, increasing the need for accessible medications for opioid use disorder (MOUD).
• Hospitalization offers a critical window for initiating MOUD treatment, but methadone access is restricted by regulations requiring dispensing through Opioid Treatment Programs (OTPs).
• These restrictions often lead to delayed hospital discharges, prolonged inpatient stays, and recurrent emergency department (ED) visits when OTPs are unavailable.

Purpose of the Study:

• To describe the implementation of hospital-based methadone dispensing under the federal 72-hour rule in a California acute care hospital.
• To evaluate the impact of this program on patient care, healthcare utilization, and costs.

Main Methods:

• A multidisciplinary approach involving legislative advocacy (Assembly Bill 2115), regulatory review, and pharmacy workflow redesign.
• Development of electronic medical record workflows and anti-stigma education initiatives.
• Evaluation of baseline data on delayed discharges and ED visits, alongside post-implementation outcomes.

Main Results:

• Prior to implementation, methadone access barriers caused 33 excess inpatient days and 15 ED visits over 7 months, costing an estimated $415,970 annually.
• Within 8 months post-implementation, 25 patients received dispensed methadone, averting at least 40 inpatient days and 12 ED visits, saving an estimated $269,164.
• Nine patients were newly initiated on methadone during their hospitalization.

Conclusions:

• Hospital-based methadone dispensing under the 72-hour rule is feasible and legally supported in California post-AB 2115.
• The program effectively reduces hospital length of stay, ED utilization, and associated healthcare costs.
• This model enhances MOUD access, improves care continuity, reduces stigma, and provides a scalable framework for other institutions.