New study supports personalized restart of methadone for opioid use disorder

A new study from University of Colorado Anschutz and Denver Health researchers, published today in JAMA Network Open, introduces a more individualized approach to restarting methadone treatment for people with opioid use disorder. The findings suggest that tailoring methadone doses to each patient's unique circumstances can improve care without compromising safety.

Methadone is a proven medication that can cut the risk of death from opioid use disorder by about 50%. The researchers considered that current treatment protocols often overlook individual patient needs, especially when restarting methadone after missed doses. Standard guidelines typically require large dose reductions, even if patients have maintained their opioid tolerance through use of non-prescribed opioids.

CU Anschutz assistant professor of internal medicine, Paul Christine, MD, PhD, was part of the team that developed and tested a new protocol that allows for more personalized methadone restart decisions. The study found that patients who restarted methadone after the new protocol was introduced received higher doses safely, with no increase in adverse events compared to traditional methods.

This study shows that we can safely tailor methadone treatment to better meet patients where they are. It's a step toward more responsive, effective care."

Paul Christine, MD, PhD, CU Anschutz assistant professor of internal medicine, physician at Denver Health

The research also reflects the changing landscape of opioid use. As the supply has shifted from heroin to more potent synthetic opioids like fentanyl, many patients enter treatment with higher tolerance levels, making individualized dosing even more critical.

Nearly 200 patients were part of the study, which was supported by Denver Health's Center for Addiction Medicine. The study reviewed nearly 500 restart episodes before and after the new protocol was introduced.

The team shared initial findings at a conference in 2024 where some methadone clinics in other states promptly adopted the protocols in the study. The full study, funded by the National Institutes of Health and Denver Health's Center for Addiction Medicine, is available in the JAMA Network Open, a peer-reviewed, open-access journal from the American Medical Association.