News: Early methadone dose adjustments linked to improved treatment retention, study finds

Early methadone dose adjustments for individuals undergoing methadone treatment in outpatient settings were found to be associated with improved treatment retention, according to a recent study published in PLOS Medicine.

Researchers used administrative data linked at the individual level to identify a cohort of more than 13,500 Ontario-based patients who started methadone treatment in an outpatient setting between January 2017 and December 2022. They examined associations between provision of an early methadone dose titration—defined as a dose increase between treatment days four to six and methadone discontinuation and opioid toxicity—compared with no dose change.

In this retrospective study, provision of an initial dose titration between treatment days four to six was found to be associated with lower rates of methadone discontinuation and opioid toxicity over six months of follow-up, compared with no dose change.

Drug titration is the process of adjusting a medication’s dosage to provide maximum benefit to an individual without adverse effects. Researchers noted that clinical guidance recommends rapid methadone titration schedules due to low rates of retention. However, this recommendation was made due to the growing opioid crisis, not clinical evidence. Thus, the researchers performed the observational study in an effort to better understand how patient outcomes are affected by methadone titration.

With their findings, researchers suggest that more should be done to address the logistical barriers that prevent patients with high opioid tolerance from receiving timely dose titration. The study was limited by a lack of comprehensive data on clinical indicators of opioid use disorder severity, such as drug use history.

Editor’s note: To read the full study, click here. To read additional coverage from JustCoding, click here.