Initiation and rapid titration of methadone and slow-release oral morphine (SROM) in an acute care, inpatient setting: a case series
Abstract Background Methadone titration in an outpatient setting typically involves initiation with subtherapeutic doses with slow titration to mitigate the risks of respiratory depression and overdose. In pregnancy, and generally, subtherapeutic doses of methadone and slow titrations are associated...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-12-01
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| Series: | European Journal of Medical Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40001-023-01538-0 |
| _version_ | 1797398090619027456 |
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| author | Laura Rodger Maya Nader Suzanne Turner Erin Lurie |
| author_facet | Laura Rodger Maya Nader Suzanne Turner Erin Lurie |
| author_sort | Laura Rodger |
| collection | DOAJ |
| description | Abstract Background Methadone titration in an outpatient setting typically involves initiation with subtherapeutic doses with slow titration to mitigate the risks of respiratory depression and overdose. In pregnancy, and generally, subtherapeutic doses of methadone and slow titrations are associated with poorer outcomes in terms of treatment retention and ongoing illicit opioid use. We aim to describe rapid titration of OAT in an inpatient setting for pregnant injection opioid users with high opioid tolerance secondary to a fentanyl-based illicit drug supply. Methods Retrospective case series of patients admitted to a tertiary center with a primary indication of opioid withdrawal and treatment for severe opioid use disorder in pregnancy. Results Twelve women received rapid methadone titrations with or without slow-release oral morphine for opioid use disorder during a total of fifteen hospital admissions. All women included in the study were active fentanyl users (12/12). Methadone dosing was increased rapidly with no adverse events with a median dose at day 7 of 65 mg (IQR 60–70 mg) and median discharge dose of 85 mg (IQR 70–92.5 mg) during their admission for titration. Slow-release oral morphine was used in half of the titration admissions (8/15) with a median dose of 340 mg (IQR 187.5–425 mg) at discharge. The median length of admission was 12 days (IQR 9.5–15). Conclusions A rapid titration of methadone was completed in an inpatient setting with or without slow-release oral morphine, without adverse events showing feasibility of this protocol for a pregnant population in an inpatient setting. Patients achieved therapeutic doses of methadone (and/or SROM) faster than outpatient counterparts with no known adverse events. |
| first_indexed | 2024-03-09T01:20:39Z |
| format | Article |
| id | doaj.art-9f1ac3eb30ef4b5ba4d8176ad29c64ed |
| institution | Directory Open Access Journal |
| issn | 2047-783X |
| language | English |
| last_indexed | 2024-03-09T01:20:39Z |
| publishDate | 2023-12-01 |
| publisher | BMC |
| record_format | Article |
| series | European Journal of Medical Research |
| spelling | doaj.art-9f1ac3eb30ef4b5ba4d8176ad29c64ed2023-12-10T12:11:59ZengBMCEuropean Journal of Medical Research2047-783X2023-12-012811710.1186/s40001-023-01538-0Initiation and rapid titration of methadone and slow-release oral morphine (SROM) in an acute care, inpatient setting: a case seriesLaura Rodger0Maya Nader1Suzanne Turner2Erin Lurie3Department of Medicine, University of TorontoDepartment of Family & Community Medicine, University of TorontoDepartment of Family Medicine, McMaster UniversityDepartment of Family & Community Medicine, University of TorontoAbstract Background Methadone titration in an outpatient setting typically involves initiation with subtherapeutic doses with slow titration to mitigate the risks of respiratory depression and overdose. In pregnancy, and generally, subtherapeutic doses of methadone and slow titrations are associated with poorer outcomes in terms of treatment retention and ongoing illicit opioid use. We aim to describe rapid titration of OAT in an inpatient setting for pregnant injection opioid users with high opioid tolerance secondary to a fentanyl-based illicit drug supply. Methods Retrospective case series of patients admitted to a tertiary center with a primary indication of opioid withdrawal and treatment for severe opioid use disorder in pregnancy. Results Twelve women received rapid methadone titrations with or without slow-release oral morphine for opioid use disorder during a total of fifteen hospital admissions. All women included in the study were active fentanyl users (12/12). Methadone dosing was increased rapidly with no adverse events with a median dose at day 7 of 65 mg (IQR 60–70 mg) and median discharge dose of 85 mg (IQR 70–92.5 mg) during their admission for titration. Slow-release oral morphine was used in half of the titration admissions (8/15) with a median dose of 340 mg (IQR 187.5–425 mg) at discharge. The median length of admission was 12 days (IQR 9.5–15). Conclusions A rapid titration of methadone was completed in an inpatient setting with or without slow-release oral morphine, without adverse events showing feasibility of this protocol for a pregnant population in an inpatient setting. Patients achieved therapeutic doses of methadone (and/or SROM) faster than outpatient counterparts with no known adverse events.https://doi.org/10.1186/s40001-023-01538-0Opioid use disorderOpioid agonist treatmentMethadoneFentanylInjection drug use |
| spellingShingle | Laura Rodger Maya Nader Suzanne Turner Erin Lurie Initiation and rapid titration of methadone and slow-release oral morphine (SROM) in an acute care, inpatient setting: a case series European Journal of Medical Research Opioid use disorder Opioid agonist treatment Methadone Fentanyl Injection drug use |
| title | Initiation and rapid titration of methadone and slow-release oral morphine (SROM) in an acute care, inpatient setting: a case series |
| title_full | Initiation and rapid titration of methadone and slow-release oral morphine (SROM) in an acute care, inpatient setting: a case series |
| title_fullStr | Initiation and rapid titration of methadone and slow-release oral morphine (SROM) in an acute care, inpatient setting: a case series |
| title_full_unstemmed | Initiation and rapid titration of methadone and slow-release oral morphine (SROM) in an acute care, inpatient setting: a case series |
| title_short | Initiation and rapid titration of methadone and slow-release oral morphine (SROM) in an acute care, inpatient setting: a case series |
| title_sort | initiation and rapid titration of methadone and slow release oral morphine srom in an acute care inpatient setting a case series |
| topic | Opioid use disorder Opioid agonist treatment Methadone Fentanyl Injection drug use |
| url | https://doi.org/10.1186/s40001-023-01538-0 |
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