PCSS-MOUD Clinical Roundtable: Methadone in Acute Care Settings-Slides

Slides

Pdf Summary

The presentation by Dr. Megan Buresh from Johns Hopkins School of Medicine discusses the initiation and use of methadone for opioid use disorder (OUD) in acute care settings, including emergency departments (ED) and hospitals. Despite frequent ED visits for OUD-related issues, only a small fraction of patients receive medications for opioid use disorder (MOUD). Recent updates allow for safer, more flexible methadone initiation in these settings, improving linkage to ongoing treatment.<br /><br />Key regulatory changes include the permanent DEA-approved "72-hour rule" update permitting hospitals to dispense up to a three-day supply of methadone upon discharge to bridge patients until they can access an opioid treatment program (OTP). This flexibility addresses barriers such as clinic closures or patient travel difficulties. Methadone can be initiated safely in the ED and inpatient settings, with dosing guided by clinical judgment rather than strict OTP regulations. Higher initial doses up to 50 mg may be necessary, especially for patients using fentanyl, with careful titration thereafter.<br /><br />Hospital-based initiation of methadone has demonstrated improved outcomes, including reduced overdose, fewer patient-directed discharges, and lowered readmissions. Interprofessional teams—including providers, nurses, pharmacists, and peer recovery coaches—play a critical role in coordinating care and ensuring smooth transitions to outpatient treatment.<br /><br />Inpatient protocols suggest rapid methadone titration with daily dose increases to reach therapeutic levels while managing withdrawal symptoms and monitoring sedation. Hospitals have the latitude to adjust methadone dosing during admission and communicate changes to outpatient providers.<br /><br />Challenges such as stigma around methadone dosing remain, but emphasis is placed on patient-centered care—assessing withdrawal control, alertness, and functional status rather than dose size alone. The presentation also highlighted the comprehensive support offered by PCSS-MOUD, a national mentoring and education program designed to enhance clinician competency in MOUD delivery.<br /><br />Overall, acute care settings represent critical opportunities to initiate and optimize methadone treatment with current regulatory flexibility and clinical best practices to improve patient outcomes in the opioid crisis.

Keywords

methadone initiation

opioid use disorder

acute care settings

emergency department

medications for opioid use disorder

72-hour rule

opioid treatment program

hospital-based methadone

interprofessional care teams

PCSS-MOUD