ORN Fall 2026 - Topics in Opioid Use Disorder: Innovations in Hospital-Initiated Methadone and Buprenorphine-2026-09-23

Video Transcription

Video Summary

The webinar, moderated by John Lepley, featured Dr. Megan Burrish of Johns Hopkins discussing innovations in hospital-initiated medication for opioid use disorder (MOUD), especially methadone and buprenorphine in the fentanyl era. She described two retrospective studies from Johns Hopkins.<br /><br />First, a mixed-methods study of hospitalized patients found a clear trend toward increasing methadone selection over buprenorphine from 2018 to 2022. Patients often chose the medication they had used successfully before, and concerns such as fentanyl exposure, prior precipitated withdrawal, or difficulty with buprenorphine influenced choices. The main takeaway was that when patients are offered all options in a patient-centered way, methadone is increasingly preferred.<br /><br />Second, a methadone dosing study showed that higher cumulative methadone doses in the first 24 hours of hospitalization were associated with lower rates of patient-directed discharge, with the strongest effect seen early in admission. This supports rapid, adequate treatment of withdrawal and highlights the importance of early initiation, including in the ED.<br /><br />Dr. Burrish also clarified key regulations: acute care hospitals can administer and dispense methadone without being OTPs, and hospitals may now dispense up to a three-day supply at discharge from the inpatient pharmacy. She emphasized that interprofessional collaboration with pharmacy, nursing, and care management is essential, and that methadone can be easier than buprenorphine for initial stabilization in some hospitalized patients.

Keywords

hospital-initiated MOUD

methadone

buprenorphine

opioid use disorder

fentanyl era

patient-centered care

patient-directed discharge

withdrawal management

acute care hospitals

Johns Hopkins