RAMP-UP: Pharmacist-Led Methadone Titration for Hospitalized Patients With Opioid Use Disorder

BACKGROUND: Hospitals increasingly start methadone treatment for opioid use disorder (OUD). Rapid methadone titration has been described in hospitals with addiction consult teams; however, most hospitals lack these specialty services. We evaluated whether a pharmacist-led rapid methadone titration protocol ("RAMP-UP") increased the proportion of hospitalizations that reached a minimally therapeutic dose of methadone (≥60 mg) before discharge. METHODS: We conducted a retrospective, quasi-experimental, pre-post study comparing outcomes 7 months before versus 7 months after the implementation of RAMP-UP. The study included all adults admitted to a large academic medical center between March 2022 and April 2023 who newly initiated methadone for OUD. We used multivariable regression with generalized estimating equations to evaluate the primary outcome of achieving a total daily methadone dose of at least 60 mg by hospital discharge. Secondary outcomes included days to therapeutic dose, total daily methadone dose, and opioid-related safety events. RESULTS: = .80). CONCLUSIONS: Pharmacist-guided rapid titration accelerated attainment of therapeutic methadone doses and did not increase adverse events. Although the adjusted increase in the proportion achieving ≥60 mg TDD by discharge was not statistically significant, these findings demonstrate how inpatient clinical pharmacists can modernize inpatient OUD care.