Operationalizing the new DEA exception: A novel process for dispensing of methadone for opioid use disorder at discharge from acute care settings

Lindsay A. Bowman, Olivia Berger, Suzanne Nesbit, Kenneth B. Stoller, Megan Buresh, Rosalyn Stewart

Research output: Contribution to journalArticlepeer-review


Purpose: To describe one strategy for dispensing of methadone at emergency department (ED) and hospital discharge implemented within 2 urban academic medical centers. Summary: Expanding access to medications for opioid use disorder (OUD) is a national priority. ED visits and hospitalizations offer an opportunity to initiate or continue these lifesaving medications, including methadone and buprenorphine. However, federal regulations governing methadone treatment and significant gaps in treatment availability have made continuing methadone upon ED or hospital discharge challenging. To address this issue, the Drug Enforcement Administration (DEA) granted an exception allowing hospitals, clinics, and EDs to dispense a 72-hour supply of methadone while continued treatment is arranged. Though this exception addresses a critical unmet need, guidance for operationalizing this service is limited. To facilitate expanded patient access to methadone on ED or hospital discharge at 2 Baltimore hospitals, key stakeholders within the parent health system were identified, and a workgroup was formed. Processes were established for requesting, approving, preparing, and dispensing the methadone supply using an electronic health record order set. Multidisciplinary educational materials were created to support end users of the workflow. In the first 3 months of implementation, 42 requests were entered, of which 36 were approved, resulting in 79 dispensed methadone doses. Conclusion: This project demonstrates feasibility of methadone dispensing at hospital and ED discharge. Further work is needed to evaluate impact on patient outcomes, such as hospital and ED utilization, length of stay, linkage to treatment, and retention in treatment.

Original languageEnglish (US)
Pages (from-to)204-218
Number of pages15
JournalAmerican Journal of Health-System Pharmacy
Issue number6
StatePublished - Mar 15 2024


  • methadone
  • opioid medication assisted treatment
  • opioid use disorder
  • pharmacy service hospital
  • substance use disorder
  • workflow

ASJC Scopus subject areas

  • Health Policy
  • Pharmacy
  • Pharmacology


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