Study objective: The "72-h rule" allows emergency department (ED) physicians to administer methadone as an induction or bridge while referring to treatment. We aimed to evaluate an ED-based program designed to increase methadone access.
Methods: We reviewed ED encounters involving methadone administration between January and August 2021. We characterized this cohort and examined the linkage and 30-day retention rates of patients linked to our partner opioid treatment program (OTP). We used logistic regression models to identify predictors of successful linkage and retention.
Results: Methadone was administered during 597 encounters with 300 unique patients. Patients presenting for a methadone dose had lengths of stay (LOS) comparable to other low acuity patients. Ninety-one percent of patients presenting for a "guest dose" continued treatment after discharge. 39 patients were initiated on methadone; 56 % completed linkage, and of those 100 % were in treatment at 30 days. A chief complaint of "methadone dose" was predictive of successful linkage and additional opioid requirement or a longer ED LOS was predictive of unsuccessful linkage.
Conclusions: ED-based methadone "guest dosing," initiation, and bridging with linkage to care can increase access to MOUD. Most patients were seen for "guest dosing," and the majority remained in treatment at 30 days. A small sample was initiated on methadone and discharged from the ED. In this limited group, initial linkage and 30-day retention rates were similar to those of inpatient methadone initiation and ED-based buprenorphine initiation. Further study of ED-based methadone initiation is warranted.
Keywords: Medication for opioid use disorder; Methadone; Opioid use disorder.
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