Trauma patients on methadone maintenance: Designing processes of care to decrease interruptions in treatment during inpatient medical admissions

Background: Interruptions in methadone maintenance treatment as a result of a medical hospital admission represent a significant barrier to timely discharge and reentry into treatment programs. Methadone use increases opiate tolerance and complicates achieving pain control following traumatic injuries. Methadone maintenance programs often deny reentry for patients using other substances including prescribed opiates. Trauma patients have high rates of drug abuse comorbidities and identification of methadone maintenance is critical to effective pain control and thus decreasing length of stay (LOS).

Methods: This retrospective cohort study, examined the medical records of all patients admitted to the trauma service from July 1, 2008 to November 1, 2008 with an identified need of methadone maintenance treatment. LOS, verification of methadone treatment and dose documentation, and date of inpatient methadone administration were analyzed.

Results: Of the 586 patients admitted during the study period, only 6 patients had clear documentation of methadone maintenance treatment. No cases had confirmation of methadone treatment and dose upon admission. There was no temporal consistency between verification of methadone dose and when methadone was first administered. Reentry into treatment was complicated for half of the cases. No clear relationship between dose verification, dose administration and LOS was found.

Implications: The lack of documentation and clear processes of care for these patients highlights the need for a protocol for to identify methadone maintenance treatment upon admission, verification of dose, and restart administration of dose. A quality initiative protocol to facilitate continuity of care for trauma patients on methadone maintenance was developed.