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Purpose of Review <p>Illicitly manufactured synthetic opioids, particularly fentanyl, now account for most drug overdose deaths in the United States (US). Methadone was first described as an effective treatment for opioid use disorders (OUD) in 1965 and exists today as a life-saving cornerstone of treatment. However, despite its proven efficacy, barriers to accessing, achieving, and maintaining effective treatment with methadone persist.</p> Recent Findings <p>Historically, strict regulations and guidelines have influenced methadone treatment in the US, including clinical decisions regarding initial dosing, rate of titration, and requirements for daily supervised dosing for those initiating care. The challenges associated with methadone treatment have grown with widespread presence of fentanyl which complicates withdrawal management and alters traditional dosing considerations.</p> Summary <p>This review explores new federal regulations, recent literature, guidelines and protocols for OUD treatment with methadone, focusing on three common clinical questions:1) initial dose titration rate, 2) dose selection after missed dosing days, and 3) take-home dose flexibilities. We outline rapid methadone initiation as an emerging strategy for individuals using fentanyl, review described methods for tailoring methadone dose after missed doses and examine the role of increased take-home dose flexibility on treatment outcomes.</p>

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Methadone for Opioid Use Disorder in the Fentanyl Era: Navigating Challenges and Evolving Strategies- a Narrative Review

  • 期刊论文

  • 发表日期：

    2025年4月29日

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  • Eugene Osagie,
  • Jacob Horton,
  • David Lawrence,
  • Gretchen Hermes,
  • Gabriela Garcia-Vassallo

摘要

Purpose of Review

Illicitly manufactured synthetic opioids, particularly fentanyl, now account for most drug overdose deaths in the United States (US). Methadone was first described as an effective treatment for opioid use disorders (OUD) in 1965 and exists today as a life-saving cornerstone of treatment. However, despite its proven efficacy, barriers to accessing, achieving, and maintaining effective treatment with methadone persist.

Recent Findings

Historically, strict regulations and guidelines have influenced methadone treatment in the US, including clinical decisions regarding initial dosing, rate of titration, and requirements for daily supervised dosing for those initiating care. The challenges associated with methadone treatment have grown with widespread presence of fentanyl which complicates withdrawal management and alters traditional dosing considerations.

Summary

This review explores new federal regulations, recent literature, guidelines and protocols for OUD treatment with methadone, focusing on three common clinical questions:1) initial dose titration rate, 2) dose selection after missed dosing days, and 3) take-home dose flexibilities. We outline rapid methadone initiation as an emerging strategy for individuals using fentanyl, review described methods for tailoring methadone dose after missed doses and examine the role of increased take-home dose flexibility on treatment outcomes.