Top

Published in:

Open Access 01-12-2021 | Buprenorphine | Case Report

Methadone initiation in a bridge clinic for opioid withdrawal and opioid treatment program linkage: a case report applying the 72-hour rule

Authors: Jordana Laks, Jessica Kehoe, Natalija M. Farrell, Miriam Komaromy, Jonathan Kolodziej, Alexander Y. Walley, Jessica L. Taylor

Published in: Addiction Science & Clinical Practice | Issue 1/2021

Abstract

Background

In the United States, methadone for opioid use disorder (OUD) is limited to highly regulated opioid treatment programs (OTPs), rendering it inaccessible to many patients. The “72-hour rule” allows non-OTP providers to administer methadone for emergency opioid withdrawal management while arranging ongoing care. Low-barrier substance use disorder (SUD) bridge clinics provide rapid access to buprenorphine but offer an opportunity to treat acute opioid withdrawal while facilitating OTP linkage. We describe the case of a patient with OUD who received methadone for opioid withdrawal in a bridge clinic and linked to an OTP within 72 h.

Case presentation

A 54-year-old woman with severe OUD was seen in a SUD bridge clinic requesting OTP linkage and assessed with a clinical opiate withdrawal scale (COWS) score of 12. She reported daily nasal use of 1 g heroin/fentanyl. Prior OUD treatment included buprenorphine-naloxone, which was only partially effective. Her acute opioid withdrawal was treated with a single observed oral dose of methadone 20 mg. She returned the following day with persistent opioid withdrawal (COWS score 11) and was treated with methadone 40 mg. On day 3, the patient was successfully admitted to a local OTP, where she remained engaged 3 months later.

Conclusions

While patients continue to face substantial access barriers, bridge clinics can play an important role in treating opioid withdrawal, building partnerships with OTPs to initiate methadone on demand, and preventing life-threatening delays to methadone treatment. Federal policy reform is urgently needed to make methadone more accessible to people with OUD.

Friedman J, Akre S. COVID-19 and the drug overdose crisis: uncovering the deadliest months in the United States, January–July 2020. Am J Public Health. 2021. https://doi.org/10.2105/AJPH.2021.306256.CrossRefPubMed

Data Brief: Opioid-related overdose deaths among Massachusetts Residents. 2021. https://www.mass.gov/doc/opioid-related-overdose-deaths-among-ma-residents-may-2021/download. Accessed 22 Oct 2021.

Santo T Jr, Clark B, Hickman M, et al. Association of opioid agonist treatment with all-cause mortality and specific causes of death among people with opioid dependence: a systematic review and meta-analysis. JAMA Psychiatry. 2021. https://doi.org/10.1001/jamapsychiatry.2021.0976.CrossRefPubMed

Bruce RD. Methadone as HIV prevention: high volume methadone sites to decrease hiv incidence rates in resource limited settings. Int J Drug Policy. 2010;21(2):122–4. https://doi.org/10.1016/j.drugpo.2009.10.004.CrossRefPubMedPubMedCentral

Alavian SM, Mirahmadizadeh A, Javanbakht M, et al. Effectiveness of methadone maintenance treatment in prevention of hepatitis C virus transmission among injecting drug users. Hepat Mon. 2013. https://doi.org/10.5812/hepatmon.12411.CrossRefPubMedPubMedCentral

Subpart C. Certification and Treatment Standards for Opioid Treatment Programs. 2021. https://www.govregs.com/regulations/title42_chapterI_part8_subpartC. Accessed 28 April 2021.

Jones CM, Campopiano M, Baldwin G, McCance-Katz E. National and state treatment need and capacity for opioid agonist medication-assisted treatment. Am J Public Health. 2015;105(8):e55-63. https://doi.org/10.2105/AJPH.2015.302664.CrossRefPubMedPubMedCentral

Rosenblum A, Cleland CM, Fong C, Kayman DJ, Tempalski B, Parrino M. Distance traveled and cross-state commuting to opioid treatment programs in the United States. J Environ Public Health. 2011;2011: e948789. https://doi.org/10.1155/2011/948789.CrossRef

Sigmon SC. Interim treatment: bridging delays to opioid treatment access. Prev Med. 2015;80:32–6. https://doi.org/10.1016/j.ypmed.2015.04.017.CrossRefPubMedPubMedCentral

10.

Gryczynski J, Schwartz RP, Salkever DS, Mitchell SG, Jaffe JH. Patterns in admission delays to outpatient methadone treatment in the United States. J Subst Abuse Treat. 2011;41(4):431–9. https://doi.org/10.1016/j.jsat.2011.06.005.CrossRefPubMedPubMedCentral

11.

Lo A, Kerr T, Hayashi K, et al. Factors associated with methadone maintenance therapy discontinuation among people who inject drugs. J Subst Abuse Treat. 2018;94:41–6. https://doi.org/10.1016/j.jsat.2018.08.009.CrossRefPubMedPubMedCentral

12.

PART 1306 - Section 1306.07 Administering or dispensing of narcotic drugs. 2021. https://www.deadiversion.usdoj.gov/21cfr/cfr/1306/1306_07.htm. Accessed 29 April 2021.

13.

Noska A, Mohan A, Wakeman S, Rich J, Boutwell A. Managing opioid use disorder during and after acute hospitalization: a case-based review clarifying methadone regulation for acute care settings. J Addict Behav Ther Rehabil. 2015. https://doi.org/10.4172/2324-9005.1000138.CrossRefPubMedPubMedCentral

14.

Harris M, Johnson S, Mackin S, Saitz R, Walley AY, Taylor JL. Low barrier tele-buprenorphine in the time of COVID-19: a case report. J Addict Med. 2020;14(4):e136–8. https://doi.org/10.1097/ADM.0000000000000682.CrossRefPubMed

15.

Snow RL, Simon RE, Jack HE, Oller D, Kehoe L, Wakeman SE. Patient experiences with a transitional, low-threshold clinic for the treatment of substance use disorder: A qualitative study of a bridge clinic. J Subst Abuse Treat. 2019;107:1–7. https://doi.org/10.1016/j.jsat.2019.09.003.CrossRefPubMed

16.

Harvey L, Taylor JL, Assoumou SA, et al. Sexually transmitted and blood-borne infections among patients presenting to a low-barrier substance use disorder medication clinic. J Addict Med. 2021. https://doi.org/10.1097/ADM.0000000000000801.CrossRefPubMed

17.

National Academies of Sciences, Engineering and Medicine. Medications for opioid use disorder save lives. Wastington DC: National Academic Press; 2019. https://doi.org/10.17226/25310.CrossRef

18.

The Biden-Harris Administration’s Statement of Drug Policy Priorities for Year One. https://www.whitehouse.gov/wp-content/uploads/2021/03/BidenHarris-Statement-of-Drug-Policy-Priorities-April-1.pdf?fbclid=IwAR2TBk34U_XRqlqK_pAYnUd_9f7zY3IbCQI9KxI6S5eYeRJdFzl9B09hZ84. Accessed 22 Oct 2021.

19.

Calcaterra SL, Bach P, Chadi A, et al. Methadone matters: what the united states can learn from the global effort to treat opioid addiction. J Gen Intern Med. 2019;34(6):1039–42. https://doi.org/10.1007/s11606-018-4801-3.CrossRefPubMedPubMedCentral

20.

Samet JH, Botticelli M, Bharel M. Methadone in primary care—one small step for congress, one giant leap for addiction treatment. N Engl J Med. 2018;379(1):7–8. https://doi.org/10.1056/NEJMp1803982.CrossRefPubMed

Title: Methadone initiation in a bridge clinic for opioid withdrawal and opioid treatment program linkage: a case report applying the 72-hour rule
Authors: Jordana Laks
Jessica Kehoe
Natalija M. Farrell
Miriam Komaromy
Jonathan Kolodziej
Alexander Y. Walley
Jessica L. Taylor
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Buprenorphine
Opioids
Opioids
Methadone
Fentanyl
Published in: Addiction Science & Clinical Practice / Issue 1/2021
Electronic ISSN: 1940-0640
DOI: https://doi.org/10.1186/s13722-021-00279-x

At a glance: The STEP trials

Springer Medicine

Methadone initiation in a bridge clinic for opioid withdrawal and opioid treatment program linkage: a case report applying the 72-hour rule

Abstract

Background

Case presentation

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Case presentation

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Electronic cigarettes’ withdrawal severity symptoms among users during intermittent fasting: a cross-sectional study

Development of an unannounced standardized patient protocol to evaluate opioid use disorder treatment in pregnancy for American Indian and rural communities

Adapting inpatient addiction medicine consult services during the COVID-19 pandemic

Advancing a cascading train-the-trainer model of frontline HIV service providers in South Africa: protocol of an implementation trial

A pilot study of the functionality and clinician acceptance of a clinical decision support tool to improve primary care of opioid use disorder

Alcohol dependence in a community sample of Aboriginal and Torres Strait Islander Australians: harms, getting help and awareness of local treatments