Abstract
Background
In an era of fentanyl and continually rising rates of opioid overdose deaths, increasing
access to evidence-based treatment for opioid use disorder (OUD) should be prioritized.
Emergency Department (ED) buprenorphine initiation for patients with OUD is considered
best-practice. Methadone, though also evidence-based and effective, is under-utilized
due to strict federal regulation, significant stigma, and lack of physician training.
We describe the novel utilization of CFR Title 21 1306.07 (b), also known as the “72-hour
rule”, to initiate methadone for OUD in the ED.
Case Series
We describe the cases of three patients with a history of OUD who were initiated on
methadone for OUD in the ED, linked to an opioid treatment program, and attended an
intake appointment.
Why should an emergency physician be aware of this?
The ED can be a crucial point of intervention for vulnerable patients with OUD who
may not interact with the healthcare system in other settings. Methadone and buprenorphine
are both first-line options for medication for opioid use disorder, and methadone
may be preferred in patients who have been unsuccessful with buprenorphine in the
past or those at higher risk of treatment dropout. Patients may also prefer methadone
to buprenorphine based on previous experience or understanding of the medications.
ED physicians may utilize the “72-hour rule” to administer and initiate methadone
for up to three consecutive days while arranging referral to treatment. EDs can develop
methadone initiation and bridge programs utilizing similar strategies to those that
have been described in developing buprenorphine programs.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
Article info
Publication history
Accepted:
January 6,
2023
Received in revised form:
January 2,
2023
Received:
October 14,
2022
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
