Initiation and Rapid Titration of Methadone in an Acute Care Setting for the Treatment of Opioid Use Disorder

by | Addiction

https://journals.lww.com/journaladdictionmedicine/Abstract/publishahead/Initiation_and_Rapid_Titration_of_Methadone_in_an.99384.aspx

Comment; I’ved used accelerated dosing to initiate methadone in the past with good results, giving a double dose for a week then cutting back to deal with the zero-order kinetics.

A Case Report

Hemmons, Patrick, MD; Bach, Paxton, MD, MSc, FRCPC; Colizza, Kate, MD, FRCPC; Nolan, Seonaid, MD, FRCPCJournal of Addiction Medicine: February 5, 2019 – Volume Publish Ahead of Print – Issue – pdoi: 10.1097/ADM.0000000000000507Case Report: PDF OnlyBUYPAP

Background: Although methadone is an effective treatment for opioid use disorder, its initiation requires prescribing at a subtherapeutic dose with subsequent titration to a therapeutic dose over many weeks. Accordingly, the methadone induction period can be a challenging one for individuals and can be associated with an increased risk for ongoing illicit drug use and consequently overdose. Given its capacity for regular clinical assessments, acute care settings may offer a unique opportunity to reduce the duration of the induction period for methadone maintenance therapy.

Case summary: We report a case of an individual who successfully completed initiation and rapid methadonetitration for treatment of opioid use disorder in an acute care setting.

Discussion: Utilizing divided dosing intervals and regular monitoring for toxicity, the patient received a cumulative methadone dose of 130 mg total within the first 48 hours of admission with continuation of a similar dose subsequently. No adverse events occurred over a 9-day follow-up period. The case report described here highlights the potential acute care settings may offer for the successful initiation and rapid titration of methadonefor the treatment of opioid use disorder. Such an approach could significantly reduce the induction period associated with methadone maintenance therapy and its associated negative outcomes including ongoing illicit substance use and risk for overdose.

Dr. Raymond Oenbrink
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