Initiation and Dose of Methadone Monotherapy vs Combination Therapy, 2015 to 2023

How have methadone prescribing practices adapted to the increasing volatility of the unregulated drug supply and evolving clinical guidance?In this repeated cross-sectional study of 70 564 initiations of methadone monotherapy and 3069 initiations of combination therapy among 35 309 unique individuals, there was a shift toward methadone initiation at 30 mg in 2018, with subsequent attainment of higher doses within 2 weeks. The release of new methadone prescribing guidance further accelerated treatment initiation at higher doses and in combination with slow-release oral morphine; however, provision of subsequent dose titration significantly declined over time.These findings suggest that the limited provision of rapid dose titration represents a potential missed opportunity for faster attainment of therapeutic doses.

Corresponding Author: Ria Garg, PharmD, Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON M5S 3M2, Canada (ria.garg@mail.utoronto.ca).

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