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 methadone for OUD treatment in a SNF despite it being 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 explained that most patients patients with OUD need higher daily doses and inadequate methadone doses can cause them to experience opioid withdrawal symptoms.
“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,” they wrote.
Researchers argued that current federal regulations make it tougher for SNFs and hospitals to provide effective OUD treatment for patients, and often result in patients 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,” the researchers concluded.
“By amending (Substance Abuse and Mental Health Services Administration) and DEA regulations to facilitate the use of methadone in both hospitals and skilled nursing facilities, federal policy can support effective care, not impede it,” they added.
The recommendations were published Monday in JAMA Internal Medicine.
