We've Been Doing it Wrong! Improving Methadone Restarts in the Fentanyl Era

Friday, April 5, 2024

1:15 PM – 2:30 PM

Presenter(s)

Joshua Blum, MD, FACP, FASAM

Medical Director, Outpatient SUD Treatment
Denver Health and Hospital Authority, Colorado

Slides Handouts
Alexandra R. Tillman, MS

Lead Epidemiologist
Denver Health & Hospital Authority, Colorado
MH

Martin Hinrichs, MD

Addiction Psychiatrist
Denver Health, Colorado
Hannan M. Braun, MD

Assistant Professor
Denver Health, Colorado

Non-presenting author(s)

HH

Hermione Hurley, MBChB

Physician
Denver Health, Colorado

Strategies to restart methadone after missed doses are dominated by conservative recommendations based on concern for loss of tolerance. This approach may be inadequate in the fentanyl era, putting clients at risk for ongoing illicit use and overdose death. This session will use didactics, quiz questions and small group case discussions to teach clinicians to adopt a more aggressive restart approach, informed by safety and satisfaction data from a treatment program in Denver, CO.

Learning Objectives:

Learners will be able to:

Demonstrate how fentanyl's behavior as a potent and long-acting opioid that promotes prolonged and high level tolerance necessitates a reconsideration of conservative restart protocols.
Apply the evidence that more aggressive restart dosing is safe and effective, without increased frequency of over-medication or overdose.
Change methadone restart protocols that result in improvements in patient and provider satisfaction.