Operationalizing the new DEA exception: A novel process for dispensing of methadone for opioid use disorder at discharge from acute care settings.

This article focuses on the implementation of a novel workflow to dispense methadone for opioid use disorder (OUD) at emergency department (ED) and hospital discharge within two urban academic medical centers in Baltimore. Following a Drug Enforcement Administration (DEA) exception allowing hospitals to dispense up to a 72-hour supply of methadone while arranging ongoing treatment, a multidisciplinary workgroup developed a structured process involving medication requests, expert approval, and pharmacy dispensing integrated into the electronic health record system. Early outcomes over three months showed 42 requests with an 86% approval rate and 79 methadone doses dispensed, demonstrating the feasibility of this approach to bridge gaps in methadone access post-discharge. The article highlights ongoing challenges, including regulatory limitations, need for coordination with opioid treatment programs (OTPs), and the importance of coupling methadone dispensing with harm reduction strategies, while noting that further research is needed to assess impacts on patient outcomes and health system utilization.