FormWeb • 8/13/21 ch Methadone initiation for narcotic addiction

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8/13/21 ch Methadone initiation for narcotic addiction

August 16, 2021

From: "Cappy Heyward" <catherine.heyward@hhsys.org>
To: "Pharmacists HHWC" <hhwc.pharmacists@hhsys.org>
Cc: "Michele Durda" <michele.durda@hhsys.org>
Sent: Friday, August 13, 2021 4:01:52 PM
Subject: methadone initiation for narcotic addiction

There have been some questions recently regarding inpatient initiation of methadone for the treatment of narcotic addiction. We have confirmed with Med Safety that methadone may be dispensed inpatient for initiation or continued treatment of narcotic addiction without any restrictions.

The methadone reference sheet on FormWeb previously stated "Confirm indication is not narcotic addiction (cannot be started in the hospital)." This statement has been removed and the document has been updated on FormWeb.

Per ACOG, "In most situations, pregnant women initiate methadone induction in a licensed outpatient opioid treatment program. Some obstetric services initiate opioid agonist therapy with methadone or buprenorphine in an inpatient setting. Although this may allow closer monitoring of medication response, it is not always necessary or available. In cases when a pregnant woman initiates methadone treatment as an inpatient, an arrangement should be made before discharge for next-day admission to an opioid treatment program so that there are no missed days. Patients started on buprenorphine as an inpatient may receive a prescription until their appointment with a licensed buprenorphine prescriber. Identification of the ongoing buprenorphine provider and scheduling of an appointment should be done before discharge.

With the exception of buprenorphine, it is currently illegal for a physician to write a prescription for any other opioids, including methadone, for the treatment of opioid use disorder outside of a licensed opioid treatment program (where medications are dispensed) 45. Buprenorphine is the only opioid agonist currently approved for the treatment of opioid use disorder by prescription in an office-based setting 46. However, methadone and buprenorphine may be dispensed in a hospital setting by physicians without waivers. Prescribers should be familiar with federal regulations (available at www.gpo.gov/fdsys/pkg/CFR-2016-title21-vol9/xml/CFR-2016-title21-vol9-sec1306-07.xml and state regulations regarding prescribing of medications for the treatment of opioid use disorder."

There is helpful dosing information in UpToDate under "Methadone and buprenorphine pharmacotherapy of opioid use disorder during pregnancy."

Please let me or Katie know if you have any questions.

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