Higher Methadone Doses at Day Seven Associated With Improved Opioid Treatment Program Retention at Day 30

Methadone is an effective treatment for opioid use disorder and higher doses are associated with improved treatment retention. However, the optimal dosing strategy during treatment induction has not been established. Recent reports suggest that more rapid up-titration during hospital admission is safe and effective, but there is less evidence to support this approach in the outpatient setting. This study assessed data from a network of 64 opioid treatment programs in the US between 2020 and 2023, using binary logistic regression to investigate the association between methadone dose at day seven of treatment and 30-day treatment retention.

• The cohort included 14,489 participants; the overall 30-day retention rate was 88 percent.
• Participants who were younger, male, and unemployed were less like to be retained in treatment for 30 days or longer.
• Analyses demonstrated a significant dose-response relationship, with higher day-seven doses predicting increased 30-day treatment retention (91 percent among patients receiving ≥70 mg methadone on day seven, versus 80 percent among those receiving <30 mg).

Comments: This study adds to other reports supporting more rapid up-titration of methadone when initiating treatment. The main concern is patient safety (i.e., overdose risk) during treatment initiation, which this study did not assess. We need more research to find the right balance between efficacy and safety.

Darius A. Rastegar, MD

Reference: Sherrick RC. Relationship between methadone induction dosing and retention in treatment in opioid treatment programs. J Addict Med. 2025 [Epub ahead of print]. doi:10.1097/ADM.0000000000001473.