Leaving Hospital Against Medical Advice After Methadone Discontinuation in the Intensive Care Unit: A Case Report

Abstract

ABSTRACT Methadone is an effective and widely used opioid agonist treatment for reduction and cessation of illicit opioid use. Once a stable dose is achieved, interruptions in treatment are not recommended given the increased risk of relapse and the potential for overdose. Despite comprehensive clinical care guidance on the initiation and administration of methadone in the outpatient setting, there is limited guidance for the continuation of methadone in the hospital or critical care setting. Additionally, little is known about potential morbidity associated with methadone treatment interruption in hospital. This case describes the clinical course of a 58-year-old female who had been on a stable dose of methadone at 120 mg daily. She was admitted to the intensive care unit following the onset of decreased level of consciousness and hypoxia with subsequent respiratory failure. Although intubated in the intensive care unit, her methadone was discontinued. Given the length of time methadone was withheld, she required re-initiation at a dose of 30 mg daily. This led to severe withdrawal symptoms, use of illicit opioids while in hospital, and eventually leaving hospital prematurely against medical advice despite potentially life-threatening active medical issues. This case highlights the potential morbidity of methadone treatment interruption in the hospital setting. Additional research is needed to understand how to manage methadone and potential treatment interruptions during acute medical illness.