Dr. Emily Skogrand, Dr. Mike Winer and Dr. Honora Englander, Methadone Outside of an OTP: Meeting People Where They Are

Medications methadone and buprenorphine – are the most effective treatments for opioid use disorder. Decades of evidence show that they treat acute withdrawal and cravings, improve quality of life, reduce risk for HIV and hepatitis C, reduce overdose, and reduce risk of drug-related and all-cause mortality. Yet in the US, fewer than 1 in 5 people with OUD accesses them.

In the US, Methadone is regulated unlike any other medication, including methadone for pain. With a few exceptions, in ambulatory settings, methadone must be administered from an opioid treatment program – a highly regulated addiction treatment setting.

This episode talks with two clinical innovators who are leading work to bring methadone into critical access points in the SUD care continuum – withdrawal management settings and the hospital.

Learning Objectives

• Describe the importance of utilizing methadone in withdrawal management settings and at hospital discharge.
• Provide practical guidance to develop processes to implement methadone administration/ dispensation via the 72h rule in non-OTP settings, drawing on experience from withdrawal management and hospital settings.
• Describe some potential challenges and examples of how to address them.
• Show what 72-hour methadone dispense has potential to achieve in withdrawal management and hospital settings.

Host & Guest Bios

1. Dr. Honora Englander is founder and Principal Investigator of the Improving Addiction Care Team (IMPACT), a nationally recognized model for hospital-based addiction care that includes physicians, social workers, and peers with lived experience in recovery. Dr Englander's work is at the intersection of addiction, health system transformation, and public health.
2. Dr. Mike Winer serves as the Medical Director of a withdrawal management center in Portland, Oregon, and is an Assistant Professor in the Section of Addiction Medicine at Oregon Health & Science University. His work focuses on clinical innovation aimed at breaking down barriers to substance use care.
3. Emily Skogrand, PharmD, is a clinical pharmacist at Oregon Health and Science University in Portland, Oregon. She works with the inpatient Internal Medicine department and on the addiction consult service with a special interest in optimizing care for patients with substance use disorders.

Timestamps:

• 00:00:00 — Intro, sponsors, goals
• 00:01:00 — Topic + guests (72-hour rule)
• 00:02:00 — Dr. Weiner background + disclosures
• 00:02:15 — Why meds (methadone/bupe) matter
• 00:03:20 — Access gap (<1 in 5 treated)
• 00:04:20 — Aim: expand methadone via 72-hour rule
• 00:05:05 — What is the 72-hour rule?
• 00:06:00 — Law expanded “administer → dispense”
• 00:07:00 — WM site use case (fentanyl era)
• 00:09:00 — Hospital challenges (discharge, OTP limits)
• 00:11:30 — Systems harm of limited access
• 00:13:00 — WM implementation steps overview
• 00:15:50 — Six key setup steps
• 00:16:40 — Hospital workflow challenges
• 00:20:00 — Need champion + team buy-

Find us online at amersa.org, and see our tweets at x.com/AMERSA_tweets.

Funding for this initiative was made possible by cooperative agreement no. 1H79TI086770 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Learn more about PCSS-MOUD at pcssnow.org.