Pilot Study to Assess the Feasibility of Randomizing Extended Length of Stay in Medically Managed Opioid Withdrawal

Provisional CDC data indicate that nationwide opioid overdose deaths declined rapidly between December 2023 and 2024, but overdose deaths remain high, and many individuals still struggle with opioid use disorder. In this collaboration with Pierce County, WA, the second most populous county in Washington, and the Metropolitan Development Council (MDC), a social service provider in the county, we will test the feasibility of randomizing the length of stay for individuals undergoing medically managed withdrawal (detox) from fentanyl. While providers of medically managed detox services believe that 10-15 days constitutes the optimal length of stay, insurers typically only cover detox stays of five days, and some patients leave even prior to that. This work will assess whether expanding coverage to more than five days can increase the completed length of stay in detox. We will also collect and analyze data on the reasons people leave detox “Against Medical Advice (AMA)". Findings will inform a larger study on the impact of detox length of stay on patient outcomes such as entry into treatment, return to detox, and health care utilization. It will also generate insights into strategies to reduce AMA departures.