{"pk":39968,"title":"Rapid Titration of Methadone for Opioid Use Disorder in the Emergency Department: A Case Report  ","subtitle":null,"abstract":"<p>Introduction</p>\n<p>The prevalence of high-potency synthetic opioids (HPSOs), such as fentanyl and its analogs, present significant treatment challenges to current strategies for Emergency Department (ED) medication for opioid use disorder (MOUD).  While most EDs traditionally use buprenorphine for MOUD, its effectiveness can be limited in patients exposed to HPSOs due to risk of precipitated withdrawal or inadequate control of withdrawal symptoms.  Methadone, a full agonist, is an alternative MOUD agent that addresses the severe withdrawal symptoms and cravings associated with HPSO dependence and will not cause precipitated withdrawal. Traditional methadone protocols often fail to provide adequate doses, but new federal guidelines allow higher initial doses and rapid titration to therapeutic levels.</p>\n<p>Case Report</p>\n<p>We report on a case of rapid methadone titration in the ED for a patient with a history of high HPSO utilization.  The patient received an initial dose of 50 mg methadone, followed by titration of hourly 10 mg doses to a cumulative 70 mg at discharge.  Vital signs, mental status, and Clinical Opiate Withdrawal Scale (COWS) scores were monitored to guide dosing.  </p>\n<p>Conclusion</p>\n<p>The protocol allowed for safe, individualized care, achieving therapeutic dosing levels that alleviated withdrawal symptoms and enabled the patient to transition to outpatient follow-up treatment.  This approach addresses the need for rapid, effective methadone initiation in an era where HPSOs pose challenges to traditional opioid use disorder treatment.</p>","language":"eng","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":"case report"},{"word":"Methadone"},{"word":"rapid titration"},{"word":"medications for opioid use disorder"},{"word":"emergency department"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/14m2m9kv","frozenauthors":[{"first_name":"Miles","middle_name":"","last_name":"Lamberson","name_suffix":"","institution":"University of Vermont Larner College of Medicine, Department of Emergency Medicine, Burlington, Vermont","department":""},{"first_name":"Roz","middle_name":"","last_name":"King","name_suffix":"","institution":"University of Vermont Larner College of Medicine, Department of Emergency Medicine, Burlington, Vermont","department":""},{"first_name":"Colin","middle_name":"T","last_name":"Waters","name_suffix":"","institution":"University of Vermont Larner College of Medicine, Department of Emergency Medicine, Burlington, Vermont","department":""},{"first_name":"Peter","middle_name":"","last_name":"Jackson","name_suffix":"","institution":"University of Vermont Larner College of Medicine, Department of Psychiatry, Burlington, Vermont; University of Vermont, Vermont Center for Behavior and Health, Center on Rural Addiction, Burlington, Vermont","department":""},{"first_name":"John","middle_name":"","last_name":"Brooklyn","name_suffix":"","institution":"University of Vermont Larner College of Medicine, Department of Psychiatry, Burlington, Vermont; University of Vermont Larner College of Medicine, Department of Family Medicine, Burlington, Vermont","department":""},{"first_name":"Elly","middle_name":"","last_name":"Riser","name_suffix":"","institution":"University of Vermont Larner College of Medicine, Department of Medicine, Burlington, Vermont","department":""},{"first_name":"Daniel","middle_name":"","last_name":"Wolfson","name_suffix":"","institution":"University of Vermont Larner College of Medicine, Department of Emergency Medicine, Burlington, Vermont","department":""}],"date_submitted":"2024-11-23T06:56:28.744000-08:00","date_accepted":"2025-01-13T14:55:22.887000-08:00","date_published":"2025-03-20T13:40:00-07:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/39968/galley/35733/download/"}]}