PCSS-MOUD Webinar: Wraparound Care Pathway for Rapid Methadone Stabilization in Hospital Settings and Linkage to Opioid Treatment Programs-Slide Materials

Slide Materials

Pdf Summary

This presentation describes a pregnancy wraparound care pathway for rapid methadone stabilization and linkage to opioid treatment programs (OTPs), designed for the fentanyl era. It highlights the rising severity of the drug supply, especially illicit fentanyl mixed with multiple adulterants, and the growing burden of maternal overdose and pregnancy-related mortality. Women remain underrepresented in MOUD treatment, with barriers including stigma, trauma, childcare responsibilities, fear of child welfare involvement, and difficulty accessing daily clinic-based care.<br /><br />The core clinical rationale is that pregnancy changes methadone metabolism and often requires higher or split dosing to maintain stable serum levels and prevent withdrawal. Split dosing can reduce peak-trough fluctuations, improve maternal comfort, support fetal stability, and reduce overdose risk. The pathway supports rapid inpatient methadone stabilization for pregnant, laboring, postpartum, and medically complex patients, especially those with severe fentanyl use or prior methadone exposure.<br /><br />A major focus is whole-person, multidisciplinary care across federal, state, system, provider, and patient levels. Recent federal OTP rule changes allow more flexible admissions, take-home doses, telehealth, and split or higher initiation dosing. Washington State funding supports rapid inpatient methadone stabilization pilots and associated education, naloxone distribution, and linkage to care.<br /><br />The pathway includes standardized roles for nursing, providers, pharmacy, care management, peers, and mental health staff, along with withdrawal monitoring, supportive medications, safety checks, and discharge planning. It emphasizes trauma-responsive, nonjudgmental care, shared decision-making, “voice and choice,” and warm hand-offs to OTPs. The presentation also includes methadone dosing protocols, monitoring for QT prolongation and sedation, and optional use of lab measures such as trough levels and methadone/metabolite ratios.<br /><br />Early program data from Washington suggest high rates of treatment completion, successful OTP linkage, naloxone distribution, and reduced hospital length of stay. The COMPASSION model extends this approach to postpartum care, family unity, and newborn support. The central message is that compassionate, coordinated, wraparound care improves safety, retention, and outcomes for birthing people with OUD.

Keywords

pregnancy

methadone stabilization

opioid treatment programs

fentanyl era

opioid use disorder

split dosing

wraparound care

maternal overdose

trauma-responsive care

naloxone distribution