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

OBJECTIVES: 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 >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-day 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 with 79.51% for those receiving <30 mg. A clear dose-response relationship was observed, with retention rates increasing as the day 7 dose increased. CONCLUSIONS: 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.