Evaluating Methadone Induction Guidelines in People Who Use Fentanyl
Grimm, Keeley E
Grimm, Keeley E
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Abstract
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.
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Date
2023-01-01