Take-home methadone provides a lifesaving bridge to recovery after hospitalization

For patients recovering from opioid use disorder, particularly from drugs like fentanyl or heroin, the days immediately following a hospital stay are among the most dangerous. A new multi-state study led by researchers at CU Anschutz found that nearly half of patients discharged with take-home methadone successfully connected to follow-up treatment within 72 hours. That window can be the difference between relapse and recovery or even life and death.

The study was published today in JAMA.

This is a moment where a life can tip one way or the other. And we now have a practical, economical, and proven way to help people stay on the path to recovery."

Susan Calcaterra, MD, MPH, MS, study's lead author and associate professor, The University of Colorado Anschutz School of Medicine

The study examined 519 hospital visits across Connecticut, Maryland and Colorado, focusing on patients discharged with take-home methadone for opioid use disorder treatment. This strategy became more accessible following a 2023 update to the Drug Enforcement Administration's "72-hour rule," which allows practitioners working outside of an opioid treatment program (OTP), also known as a methadone clinic, to dispense (but not prescribe) up to three days of narcotics to manage acute withdrawal while formal treatment is arranged.

Researchers found that 44% of patients who received take-home methadone successfully connected to an OTP within 72 hours. The likelihood of successful follow-up increased if patients were already enrolled in an OTP, discharged to a structured care setting like a rehab facility or received higher methadone doses. Conversely, patients who used stimulants such as methamphetamine or cocaine alongside opioids were less likely to engage in follow-up care.

"The take-home methadone doses serve as a critical bridge when treatment isn't immediately available, especially when a patient is discharged from the hospital on a weekend or a holiday when OTPs are closed or have limited hours, leading to a delay in medication treatment access," said Calcaterra.

Calcaterra emphasized that untreated opioid withdrawal can cause a person to return to unprescribed opioid use, increasing their risk of overdose and death.

"Providing take-home methadone doses ensures the patient has sufficient time to connect to the OTP after hospital discharge before experiencing opioid withdrawal. Whereas before, patients had to connect to the OTP in less than 24 hours from the time of their last methadone dose to avoid uncomfortable opioid withdrawal symptoms, a challenge for people who are weak and deconditioned following a hospitalization," said Calcaterra.

Hospitals that had strong partnerships with OTPs and post-acute care facilities saw better outcomes. Shared electronic health records, coordinated discharge plans and formal agreements between hospitals and treatment providers all contributed to higher follow-up rates.

"What made the biggest difference in linkage from the hospital to the OTP was the combination of the medication and the support system built around it. . When hospitals, clinics and caregivers work together, patients are far less likely to fall through the cracks," said Calcaterra.

As overdose deaths continue to rise nationwide the findings offer a realistic, evidence-based solution that hospitals can adopt immediately.

"This isn't a major overhaul, it's a simple low-cost intervention that can keep someone alive during a critical few days," said Calcaterra. "In a crisis, something as small as a few take-home meathdone doses can give people the time they need to get connected to life-saving treatment and stay in recovery."

The study was a collaboration between University of Colorado Anschutz; Yale School of Medicine; Yale School of Public Health; UCHealth; Skaggs School of Pharmacy and Pharmaceutical Sciences; Johns Hopkins School of Medicine; Johns Hopkins Bloomberg School of Public Health; The Johns Hopkins Hospital; and Johns Hopkins Bayview Medical Center.

This research was conducted by Susan Calcaterra, MD, MPH, MS; Melissa B. Weimer, DO, MCR; Eric Grimm, MS; Yevgeniya Scherbak, PharmD; Rawan Abdel Galil, MBBS; Olivia Berger, PharmD; Lindsay A. Bowman, PharmD; Suzanne A. Nesbit, PharmD; Alexandra Barany, PharmD, MBA; and Megan Buresh, MD.