Date of Publication
Dr. Rosemary Dale, Ed. D., APRN
BACKGROUND: Methadone is a medication provided to those with opioid use disorder. There has been a rise in people testing positive for fentanyl at medication for opioid use disorder (MOUD) clinics. The increased potency of fentanyl has challenged providers when stabilizing patients on methadone.
PURPOSE: This project aims to improve the effectiveness of methadone induction protocols in patients who test positive for fentanyl at a MOUD clinic.
METHODS: A retrospective chart review was conducted to evaluate patients who sought treatment between November 2019-February 2020. 80 patient charts were reviewed and 12 data points were collected.
RESULTS: 50 of the 80 patients were prescribed methadone. Of those, 23 patients (46%) tested positive for fentanyl on their first urine drug screen (UDS). There was a 2% difference in retention when comparing patients who initially tested positive for fentanyl compared to those who initially tested negative for fentanyl. Following induction, 90% of patients tested positive for fentanyl. Mean methadone doses differed between those who tested positive for fentanyl (67 mg) and those who tested negative (75 mg). After one year, 53% of patients tested positive for fentanyl. Mean methadone doses differed between those who tested positive for fentanyl (82 mg) and those who tested negative (102 mg).
CONCLUSION: Areas of practice have been identified that would benefit from improvement, such as the assessment tool used and protocols for ancillary medication. Further research is needed to identify long-term solutions to the opioid epidemic with the rise of synthetic opioids, such as fentanyl.
Grimm, Keeley E., "Evaluating Methadone Induction Guidelines in People Who Use Fentanyl" (2023). College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications. 125.
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