Quick Guide: Methadone Starts in the Hospital Day 1: max daily dose 40 mg methadone First dose • Check COWS and Ramsay • Administer 10-30mg methadone • Recheck Ramsay in 1 hour After 4 hours • If endorsing withdrawal/cravings, check Ramsay • If no sedation, order additional 5 - 10 mg dose • Recheck Ramsay in 1 hour After 4 hours • If endorsing withdrawal/cravings, check Ramsay • If no sedation and not at max daily dose, order additional 5-10 mg dose • Recheck Ramsay in 1 hour Day 2: max daily dose 50 mg methadone First dose • Check Ramsay, proceed if no sedation • Give total daily dose from day 1 as single dose • Recheck Ramsay in 1 hour After 4 hours • If endorsing withdrawal/cravings, check Ramsay • If no sedation, order additional 5 - 10 mg dose • Recheck Ramsay in 1 hour After 4 hours • If endorsing withdrawal/cravings, check Ramsay • If no sedation and not at max daily dose, order additional 5-10 mg dose • Recheck Ramsay in 1 hour adone Ramsay sedation score: 1. Anxious/restless 2. Cooperative/oriented/tranquil 3. Response to commands 4. Brisk response to stimulus 5. Sluggish response to stimulus 6. No response to stimulus Support for Hospital Opioid Use Treatment (SHOUT) #Methadone #Initiation #Algorithm #Treatment #Management #Addiction #Opiate #Start #Prescribing #Inpatient #opioid
