Methadone 72 Hour Rule

Background

Methadone is very effective for treatment of OUD, particularly in individuals using fentanyl/high potency synthetic opioids, for which buprenorphine may not provide sufficient relief from withdrawal symptoms.

Access to methadone OTPs is challenging in many communities, with waitlists and barriers to admission, including not being open to new cases on weekends, in some cases

The 72 hour rule allows EDs to administer methadone as induction or bridge while referring to treatment

Can dispense but not prescribe 72 hours worth of methadone for OWS or OUD at discharge (i.e. take home doses) - relevant for weekends/holidays

Coming up more frequently in emergency medicine practice, and Eds have a chance to help reduce opioid use and overdose risk by implementing this rule

“Nothing in this section shall prohibit a practitioner, who is not specifically registered to conduct a narcotic treatment program, from dispensing (but not prescribing) narcotic drugs, in accordance with applicable Federal, State, and local laws relating to controlled substances, to one person or for one person's use at one time for the purpose of initiating maintenance treatment or detoxification treatment (or both). Not more than a three-day supply of such medication may be dispensed to the person or for the person's use at one time while arrangements are being made for referral for treatment. Such emergency treatment may not be renewed or extended.”