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Things We Do for No Reason™: Avoiding methadone for opioid withdrawal

Year: 2023

Type: article

Abstract: The "Things We Do for No Reason" series reviews practices, which have become common parts of hospital care, may provide little value to our patients.Practices reviewed in the TWDFNR series do not represent "black and white" conclusions or clinical practice standards, but are meant as a starting place for research and active discussions among hospitalists and patients.We invite you to be part of that discussion. CLINICAL SCENARIOA 37-year-old woman with opioid use disorder (OUD) hospitalized for cellulitis shares that she injects 1 g of fentanyl daily.She fears starting buprenorphine due to precipitated withdrawal and asks for methadone.Instead, the hospitalist starts her on 10 mg of oxycodone every 4 h.On hospital Day 2, she self-discharges. WHY HOSPITALISTS AVOID OFFERING METHADONE FOR OPIOID WITHDRAWALMethadone, buprenorphine, and extended-release naltrexone are the three Food and Drug Administration (FDA) approved medications for OUD.Methadone is a schedule II-controlled substance and in US ambulatory settings, only Opioid Treatment Programs (OTPs) can dispense methadone-with few exceptions. 1 Strict ambulatory regulations

Source: Journal of Hospital Medicine

DOI: 10.1002/jhm.13138

Authors: Marlene Martin, Honora Englander, Susan L. Calcaterra