{"pk":18030,"title":"A Novel Use of the “3-Day Rule”: Post-discharge Methadone Dosing in the Emergency Department","subtitle":null,"abstract":"<p><strong>Introduction:</strong> Methadone is a medically necessary and lifesaving medication for many patients with opioid use disorder. To adequately address these patients’ needs, methadone should be offered in the hospital, but barriers exist that limit its continuation upon discharge. The code of federal regulations allows for methadone dosing as an inpatient as well as outpatient dispensing for<br>up to three days to facilitate linkage to treatment. As a quality initiative, we created a new workflow for discharging patients on methadone to return to the emergency department (ED) for uninterrupted dosing.</p>\n<p><strong>Methods:</strong> Our addiction medicine team changed hospital methadone policy to better allow hospitalization as a window of opportunity to start methadone. This necessitated the creation of a warm-handoff process to link patients to methadone clinics if that linkage could not happen immediately on discharge. Thus, our team created the “ED Bridge” process, which uses the “3-day rule” to dispense methadone from the ED post hospital discharge. We then followed every patient we directed through this workflow as an observational cohort for outcomes and trends.</p>\n<p><strong>Results:</strong> Of the patients for whom ED bridge dosing was planned, 40.4% completed all bridge dosing and an additional 17.3% received at least one but not all bridge doses. Established methadone patients made up 38.1% of successful linkages, and 61.9% were patients who were newly started on methadone in the hospital.</p>\n<p><strong>Conclusion:</strong> Improving methadone as a treatment option remains an ongoing issue for policymakers and advocates. Our ED bridge workflow allows us to expand access and continuation of methadone now using existing laws and regulations, and to better use hospitals as a point of entry into methadone treatment.</p>","language":null,"license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Methadone"},{"word":"addiction"},{"word":"opioid use disorder"},{"word":"emergency department"}],"section":"Behavioral Health","is_remote":true,"remote_url":"https://escholarship.org/uc/item/6hq9k398","frozenauthors":[{"first_name":"Jenna","middle_name":"K.","last_name":"Nikolaides","name_suffix":"","institution":"Rush University Medical Center, Substance Use Intervention Team, Department of Psychiatry and Behavioral Sciences, Chicago, Illinois; Rush University Medical Center, Department of Emergency Medicine, Chicago, Illinois","department":"None"},{"first_name":"Tran","middle_name":"H.","last_name":"Tran","name_suffix":"","institution":"Rush University Medical Center, Substance Use Intervention Team, Department of Psychiatry and Behavioral Sciences, Chicago, Illinois; Chicago College of Pharmacy, Midwestern University, Downers Grove, Illinois","department":"None"},{"first_name":"Elisabeth","middle_name":"","last_name":"Ramsey","name_suffix":"","institution":"Rush University Medical Center, Substance Use Intervention Team, Department of Psychiatry and Behavioral Sciences, Chicago, Illinois","department":"None"},{"first_name":"Sophia","middle_name":"","last_name":"Salib","name_suffix":"","institution":"Rush University Medical Center, Substance Use Intervention Team, Department of Psychiatry and Behavioral Sciences, Chicago, Illinois","department":"None"},{"first_name":"Henry","middle_name":"","last_name":"Swoboda","name_suffix":"","institution":"Queen’s University, Department of Emergency Medicine and Addictions Medicine, Kingston, Canada","department":"None"}],"date_submitted":"2023-03-31T21:28:59Z","date_accepted":"2023-03-31T21:28:59Z","date_published":"2024-06-11T13:00:00Z","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18030/galley/14439/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18030/galley/10544/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18030/galley/14439/download/"}]}