The article, “Rapid Methadone Induction in a General Hospital Setting: A Retrospective, Observational Analysis,” has been published in SAj.
In this commentary, the authors state that outpatient methadone guidelines recommend starting at a low dose and titrating slowly. As fentanyl prevalence and opioid-related mortality increases, there is a need for individuals to rapidly achieve a therapeutic methadone dose. Hospitalization offers a monitored setting for methadone initiation, however dosing practices and safety are not well described.
In the AUTHORS’ OWN WORDS, they relate the importance of their work:
“In this retrospective analysis of hospitalized patients with OUD who were newly initiated on methadone by an inpatient addiction consult team, patients were titrated more rapidly than traditional OTP initiation dosing with only 3.5% of patients experiencing a safety event probably or definitely related to methadone. In all cases the safety event was oversedation not requiring naloxone. Patients who experienced an oversedation event that was possibly related to methadone had higher final methadone doses than those who did not experience any sedation events. More than three-quarters (76%) of patients were successfully connected to an OTP prior to discharge.”
“These findings suggest that hospitalization may offer an opportunity to safely initiate methadone with a more rapid dosing titration than what is currently utilized in outpatient settings.”