Low-threshold Methadone Bridge Clinic Facilitates Linkage to Treatment for Opioid Use Disorder

In the US, federal regulations restrict the outpatient administration of methadone for opioid use disorder to licensed opioid treatment programs (OTPs). To relieve acute withdrawal while arranging a referral to an OTP, the regulations permit non-OTP-affiliated clinicians to administer methadone for up to 72 hours as a bridge to treatment, 1 day at a time. Clinicians at Boston Medical Center developed a walk-in methadone bridge clinic using this “72-hour rule” to address barriers in access to methadone.

  • 142 patients received a mean of 2.1 days of emergency opioid withdrawal treatment during the evaluation period; 85% had fentanyl-positive urine drug test results.
  • For de novo methadone initiation (n=139), the mean day 1 methadone dose was 28.4 mg, day 2 was 37 mg, and day 3 was 43 mg.
  • 105 out of 121 (87%) referrals resulted in successful OTP linkage.
  • At one month, 58% of total referrals (70 of 121) were retained in care at the referred OTP.

Comments: This study demonstrates that emergency methadone withdrawal treatment and OTP linkage in an outpatient bridge clinic is feasible and facilitates access to methadone. This model may be of particular use during care transitions, such as exiting the criminal justice system or discharge from a hospital. As of March 2022, the Drug Enforcement Agency is allowing non-OTP prescribers to request an exemption to dispense a 3-day supply of methadone. The added flexibility for dispensing a 3-day supply provides an opportunity for expansion of these types of services.

Lea Selitsky, MD, MPH* & Darius A. Rastegar, MD

* Contributing editorial intern and addiction medicine fellow, Johns Hopkins Medicine

Reference: Taylor JL, Laks J, Christine PJ, et al. Bridge clinic implementation of “72-hour rule” methadone for opioid withdrawal management: impact on opioid treatment program linkage and retention in care. Drug Alcohol Depend. 2022;236:109497.

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