Relationship Between Methadone Induction Dosing and Retention in Treatment in Opioid Treatment Programs

Relationship Between Methadone Induction Dosing and Retention in Treatment in Opioid Treatment Programs

Published: July/August 2025
Journal Article

Overview

This one-hour, on-demand, journal article-based activity examines the relationship between methadone dosing during the first week of treatment and 30-day treatment retention. This article addresses early dropout challenges and offers solutions to patients' adherence to treatment.  

The target audience for this intermediate continuing education activity includes: physicians, nurse practitioners, physician assistants, pharmacists and other clinicians, researchers, students, and policymakers.

This activity addresses the following ACGME Core Competencies: Patient Care, Medical Knowledge, Practice-based Learning and Improvement, and Systems-Based Practice  

Abstract

Aims 

Methadone medication for opioid use disorder is effective in reducing opioid use and associated risks, but early dropout from treatment remains a challenge. Current guidelines recommend conservative methadone dose titration, yet slower dose escalation may lead to continued withdrawal symptoms, opioid use, or premature treatment discontinuation. This study investigates the relationship between the first week of methadone dosing and 30-day treatment retention.

Methods

This retrospective cohort study included 14,489 patients newly admitted to a network of 64 OTPs between 2020 and 2023. Patients who received an initial methadone dose greater than 30 mg or missed any dosing during the first week were excluded. The primary outcome was 30-day retention. Logistic regression was used to examine the association between methadone dose at day 7 and 30-day retention.

Results

Higher methadone doses on day 7 were significantly associated with improved 30-day retention (p < 0.0001). Patients receiving 70 mg or more on day 7 had a retention rate of 91.24%, compared to 79.51% for those receiving less than 30 mg. A clear dose-response relationship was observed, with retention rates increasing as the day 7 dose increased.

Conclusion

More rapid methadone induction, particularly higher doses by day 7, is associated with improved 30-day retention. Current conservative induction guidelines may need to be revised to allow for more rapid dose escalation while balancing improved treatment outcomes with safety. Further research is necessary to assess the impact of methadone induction dosing on mortality and adverse events.

Learning Objectives

Upon completion of this activity, learners will be able to:

1. Identify factors that contribute to early dropout during methadone treatment, particularly within the first 30 days. 
2. Analyze the key findings from the cohort study on methadone induction, including patient demographics, dosing patterns, and their association with 30-day treatment retention. 
3. Apply knowledge of early methadone dosing strategies to support clinical decisions that balance patient safety and improve treatment retention during the first 30 days. 

Registration Rates

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Refunds & Cancellations

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Open Registration: 07/30/2025 - 02/03/2028

Close Access Date: 02/03/2028

Course Instructions

1. Click on the Contents tab to begin this activity.
2. Click Download Journal Article in the box titled Journal Article and read the journal article in its entirety. 
3. Click Complete Post-Test to answer multiple-choice questions. Participants will have 10 attempts to pass and must answer 2 out of 3 questions correctly.
4. Click Complete Evaluation to provide valuable activity feedback. Scroll down on all questions, as there may be answer options that expand past the size of the window.
5. Click the button Claim Medical Credits in the box titled Claim Credits & Certificate. Choose the type of credit and click submit. Click the button View/Print Certificate to save or print your certificate. You can view/print your certificate at any time by visiting the ASAM eLearning Center, clicking Dashboard, and clicking Transcript/Achievements.

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Accreditation & Credits

Joint Accreditation Statement

In support of improving patient care, the American Society of Addiction Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Credits Available

• Physicians: 1.00 Credit
• Nurses & NPs: 1.00 Nursing Contact Hour
• PAs: 1.00 Credit
• Pharmacology Hour: 1 Hour
  
• Interprofessional Continuing Education: 1.00 Credit
• Certified Counselors: NBCC Contact Hours Not Offered

  

  American Society of Addiction Medicine has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 7062. Programs that do not qualify for NBCC credit are clearly identified. American Society of Addiction Medicine is solely responsible for all aspects of the programs.

Maintenance of Certification (MOC)/Continuing Certification Program (CCP)

This activity is designed to meet the requirements for MOC/CCP for several primary physician boards and for state licensing CME requirements. MOC Credit is only reported and designated for ABA, ABP, ABIM, and ABS. By completing the online credit application and evaluation, the learner permits ASAM to report credits to the appropriate Board. Learn more.

• ABIM MOC Points: 1.00 Medical Knowledge
• ABP MOC: 1.00 Lifelong Learning & Self-Assessment
• ABS Continuing Certification: 1.00 Accredited CME
• ABA MOCA 2.0®*: 1.00 Lifelong Learning MOCA 2.0® is a trademark of the American Board of Anesthesiology®. This activity contributes to the CME requirement for Part II: Lifelong Learning and Self-Assessment of the American Board of Anesthesiology's (ABA) redesigned Maintenance of Certification in Anesthesiology Program® (MOCA®), known as MOCA 2.0®. Please consult the ABA website, https://www.theaba.org/, for a list of all MOCA 2.0 requirements.

Additionally, this activity has been designed to satisfy the requirements of the following primary physician board certification requirements. Please confirm with your individual Board.

• American Board of Addiction Medicine (ABAM)
• American Board of Preventive Medicine (ABPM)
• American Board of Psychiatry and Neurology (ABPN)
• Royal College of Physicians and Surgeons of Canada (RCPSC)

Certificates for other professions

All participants may request a certificate of participation upon completion of the activity and an online evaluation confirming their participation. Learners are strongly advised to contact their professional licensing board or professional association to confirm this certificate will be accepted as evidence supporting continuing education requirements.

California Association for Drug/Alcohol Educators (CAADE)

This educational program is approved by CAADE: #CP40 999 1225.

California Association of DUI Treatment Centers (CADTP)

This educational program is approved by CADTP: #205.

California Consortium of Addiction Programs and Professionals (CCAPP)

This educational program is approved by CCAPP: #OS-20-330-0227.

Disclosure Information

In accordance with the disclosure policies of ASAM and Joint Accreditation, the effort is made to ensure balance, independence, objectivity, and scientific rigor in all accredited continuing education activities. These policies include identifying and mitigating all relevant financial relationships with ineligible companies for those involved in the creation and dissemination of accredited continuing education. 

See the attached article and pdf for a list of disclosures