A study conducted by Denver Health researchers and published in JAMA Network Open proposes a more individualized approach to restarting methadone treatment for individuals with opioid use disorder. The research suggests that adjusting methadone doses based on each patient’s specific situation can enhance care while maintaining safety.
Methadone has been shown to reduce the risk of death from opioid use disorder by about half. However, current protocols for restarting methadone after missed doses often require significant dose reductions, even if patients have continued using non-prescribed opioids and maintained their tolerance.
Paul Christine, MD, PhD, a physician at Denver Health, was among the researchers who developed and evaluated a new protocol allowing for more personalized decisions when restarting methadone. According to the study, patients who restarted methadone under this protocol received higher doses safely and experienced no increase in adverse events compared to those following traditional methods.
“This study shows that we can safely tailor methadone treatment to better meet patients where they are,” said Christine. “It’s a step toward more responsive, effective care.”
The research also addresses changes in the opioid landscape. As fentanyl and other synthetic opioids have become more common than heroin, many patients begin treatment with higher levels of opioid tolerance. This shift makes individualized dosing increasingly important.
The study involved nearly 200 patients and examined almost 500 episodes of methadone restarts before and after implementation of the new protocol. The project was supported by Denver Health’s Center for Addiction Medicine. Researchers included Joshua Blum, MD; Alexandra Tillman, MS; Hannan Braun, MD; Martin Hinrichs, MD; Hermione Hurley, MD; and Alia Al-Tayyib, PhD. Preliminary results were presented at a 2024 conference where some clinics in other states quickly adopted the protocols described in the study.
Funding for the full study came from the National Institutes of Health and Denver Health’s Center for Addiction Medicine. The complete findings are available through JAMA Network Open, an open-access journal published by the American Medical Association.
