What Happens if You Miss a Few Days of Methadone Doses?

Dr. Julio Nunes Discusses Addiction Treatment and the Modernizing Addiction Treatment Access Act

On July 28, the The American Journal of Drug and Alcohol Abuse published an article [https://www.tandfonline.com/doi/10.1080/00952990.2025.2525405?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed#abstract] describing the bipartisan Modernizing Opioid Treatment Access (MOTA) Act [https://dailymat.substack.com/p/the-modernizing-opioid-treatment], a bill that is currently making its way through the house and senate that would allow board certified addiction psychiatrists to prescribe 30-day supplies of methadone to be picked up at your local pharmacy, instead of at an opioid treatment center (OTP). I spoke with first author of the article, Julio Nunes, MD [https://medicine.yale.edu/profile/julio-nunes/], an addiction psychiatry resident at Yale University, and board member at the Doctors for Drug Policy Reform [https://www.d4dpr.org/], about treatment for opioid use disorders, stigma, what the bill would do, and what we can all do if we want to support it. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit dailymat.substack.com [https://dailymat.substack.com?utm_medium=podcast&utm_campaign=CTA_1]

What Happens if You Miss a Few Days of Methadone Doses?

There were audible gasps in the room when researchers presented the preliminary findings of this paper—showing that when patients who restarted methadone after several missed doses were given a say, they almost always restarted at the same dose they'd been taking. Conventional protocols recommend dramatically cutting a person's methadone dose after missed clinic visits. The assumption is that their tolerance has decreased, but that ignores the reality that many people may have been using opioids in the interim. Dr. Paul Christine explains how his research showed that these higher doses were not only safe, but kept people out of the emergency room. His research relied on shared decision making, a concept that is common in many medical practices but is just starting to make its way into opioid treatment centers. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit dailymat.substack.com [https://dailymat.substack.com?utm_medium=podcast&utm_campaign=CTA_1]