E3 - Split-Dosing of Methadone in Pregnancy and Postpartum – Rationale, Effectiveness, and Implementation

Wednesday, May 22, 2024

8:15 AM – 9:45 AM PST

Location: Willshire Ballroom

CE: 1.5

Primary Presenter(s)

Dennis Hand, PhD (he/him/his)

Associate Professor
Thomas Jefferson University
Philadelphia, Pennsylvania

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Co-Presenter(s)

Vania P. Rudolf, MD, MPH, DFASAM

Medical Director, Addiction Recovery Services
Swedish Medical Group
Seattle, Washington
John McCarthy, MD

Associate Professor of Psychiatry
University of California, Davis
Homewood, California

Presentation Summary: Methadone is an effective medication for opioid use disorder (OUD) in pregnancy and postpartum, especially when combined with comprehensive medical, behavioral, and related care. Pregnancy-related changes in a person’s body affect how they process methadone, often requiring increased and multiple methadone doses per day, called ‘split-dosing’ in order to sustain stability. Recent and forthcoming changes in federal dosing regulations and recommendations from SAMHSA make split-dosing easier to provide. This workshop will review the rationale behind dosing frequency for peripartum people, pregnant people with OUD and treatment staff experiences and challenges, and the effectiveness of split-dosed methadone and its implementation.

Learning Objectives:

At the completion of this activity, participants will:

Describe the benefits, limitations, and unknown outcomes of split-dosing in pregnancy and postpartum
Describe tools for measuring methadone metabolism and monitoring physiology and clinical information to inform dosing strategies
Describe the considerations of people with opioid use disorder that must be factored into providing split dosing