Johns Hopkins University researchers are calling on the federal government to change its regulations on methadone doses in order to improve care for patients in skilled nursing facilities and hospitals being treated for opioid use disorder. 

They argued that the Drug Enforcement Agency should amend its regulations to allow for the continued use of methadone for OUD treatment in SNFs. This would include cases in which methadone use was initiated during a hospitalization. They also recommended the treatment be used until the patient can enroll in an opioid treatment program. 

Additionally, they contended that regulations should allow hospitals to initiate and adjust the dose of methadone to effectiveness during hospitalizations. Providers also should have the ability to transfer patients to an opioid treatment program at the discharge dose, they wrote. 

The researchers explained that most patients with OUD need higher daily doses. Inadequate methadone doses can cause them to experience opioid withdrawal symptoms, they said.

“The situation for patients who are transferred to skilled nursing facilities is even worse. The reason is that DEA regulations prohibit skilled nursing facilities from starting methadone treatment on their own or continuing methadone treatment initiated during a preceding hospitalization without enrollment in an opioid treatment program,” wrote Jarratt D. Pytell, M.D., and colleagues. 

Current federal regulations make it tougher for SNFs and hospitals to provide effective OUD treatment for patients, the researchers argued. Patients end up going through “cycles of complications, admission, discharge, repeated complications and readmission with little gain to their health.” 

“For many patients with OUD, effective treatment with methadone may be one of the most important therapies that a hospital or skilled nursing facility can provide,” they concluded. 

The recommendations were published Monday in JAMA Internal Medicine.