Evaluation of a Novel Patient-Centered Methadone Restart Protocol 🔓

JAMA Network Open

Restarting methadone for patients who have had a gap in treatment is often a frustratingly slow process for both the patient and provider. This cohort study of individuals examined outcomes for patients of a public, safety-net opioid treatment program before (n=786 patients) and after (n=780 patients) implementation of a 2022 clinical protocol focused on individualized methadone restart doses based on opioid tolerance. Preimplementation restart doses were 32.8% lower than the last prior methadone dose, whereas postimplementation restart doses were only 3.4% lower than the last prior methadone dose. There was no significant change in patient safety (emergency department visits within 7 days after restart and all-cause mortality within 7 and 90 days after restart) or 90-day retention in care.

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Recommendations for Addressing In-Hospital Substance Use From a National Delphi Consensus Process

JAMA Network Open

This survey study utilized a 3-round Delphi consensus process to identify best practices for addressing in-hospital substance use. A panel of 38 addiction experts developed 84 consensus-based and patient-centered recommendations which can inform local responses, including policies, to address in-hospital substance use.

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Injectable-Only Overlapping Buprenorphine Starting Protocol in a Low-Threshold Setting

JAMA Network Open

Injectable-only buprenorphine protocols are an exciting new strategy for buprenorphine initiation, particularly in the fentanyl era. This is a cohort study of 95 patients with moderate to severe opioid use disorder who received care in a low-threshold setting in Seattle. 79% of patients included in the study were experiencing homelessness or living in permanent supportive housing. Patients selected a long-acting injectable (LAI) buprenorphine initiation protocol which included three escalating doses of LAI buprenorphine over three days, with no sublingual buprenorphine and without cessation of fentanyl/opioid use. 75% of the patients completed the protocol, and 64% received a second monthly dose of LAI buprenorphine.

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