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Î The administration of methadone should be monitored because
unsupervised administration can lead to misuse and diversion.
• OTP regulations require monitored medication administration until the patient's
clinical response and behavior demonstrates that the prescribing of non-monitored
doses is appropriate.
Î MAJOR REVISION – Patients' psychosocial needs should be assessed,
and patients should be offered or referred to psychosocial treatment
based on their individual needs, in conjunction with methadone in the
treatment of OUD.
• However, a patient's decision to decline psychosocial treatment or the absence
of available psychosocial treatment should not preclude or delay treatment with
methadone, with appropriate medication management.
• Motivational interviewing or enhancement can be used to encourage patients
to engage in psychosocial treatment services appropriate for addressing their
individual needs.
Î For patients who previously received methadone for the treatment of
OUD, methadone should be reinstituted immediately if relapse occurs
or if an assessment determines that the risk of relapse is high (unless
contraindicated).
• Re-initiation of methadone should follow the recommendations above regarding
initial dose and titration.
Î Strategies directed at relapse prevention are an important part of
comprehensive addiction treatment and should be included in any
plan of care for a patient receiving active opioid treatment or ongoing
monitoring of the status of their addictive disease.
Î Strategies directed at relapse prevention are an important part of
addiction treatment and should be included in any plan of care for a
patient receiving OUD treatment or ongoing monitoring of the status of
their disorder.
Î Transitioning from methadone to another medication for the treatment
of OUD may be appropriate if the patient experiences dangerous or
intolerable side effects or is not successful in attaining or maintaining
treatment goals through the use of methadone.
Î Patients transitioning from methadone to buprenorphine in the
treatment of OUD should ideally be on low doses of methadone before
making the transition.
• Patients on low doses of methadone (30–40mg per day or less) generally tolerate
transition to buprenorphine with minimal discomfort, whereas patients on
higher doses of methadone may experience significant discomfort in transitioning
medications.
