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

Last registered on June 23, 2025
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Pre-Trial

Trial Information

General Information

Title
Pilot Study to Assess the Feasibility of Randomizing Extended Length of Stay in Medically Managed Opioid Withdrawal
RCT ID
AEARCTR-0016250
Initial registration date
June 19, 2025

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
June 23, 2025, 12:06 PM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Locations

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Primary Investigator

Name
Mireille Jacobson
Affiliation
USC
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Other Primary Investigator(s)

PI Name
Tom Chang
PI Affiliation
USC
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PI Name
David Powell
PI Affiliation
RAND
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Additional Trial Information

Status
In development
Start date
2025-07-07
End date
2026-06-01
Keywords
Health
Additional Keywords
medically managed detoxification
JEL code(s)
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
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 length of stay for individuals undergoing medically managed withdrawal (detox) from fentanyl. While providers of medically managed detox services believe that 10-15 days constitute 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” or 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.
External Link(s)

Registration Citation

Citation
Chang, Tom, Mireille Jacobson and David Powell. 2025. "Pilot Study to Assess the Feasibility of Randomizing Extended Length of Stay in Medically Managed Opioid Withdrawal." AEA RCT Registry. June 23. https://doi.org/10.1257/rct.16250-1.0
Sponsors & Partners

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Experimental Details

Interventions

Intervention(s)
Patients presenting for medically managed detox from fentanyl will be randomized to a standard or extend length of stay. Staff provide details on the covered length of stay at a planning meeting that usually occurs on the 2nd day in detox. We will provide a randomization sequence for length of stay offers to patients who are admitted for detox from fentanyl. Patients admitted for detox from other substances, most commonly alcohol or some combination of substances, will not be included in the offer per Pierce County and MDC agreement.
Intervention Start Date
2025-07-07
Intervention End Date
2026-05-29

Primary Outcomes

Primary Outcomes (end points)
length of stay in detox
Primary Outcomes (explanation)
Days from admission into detox to discharge

Secondary Outcomes

Secondary Outcomes (end points)
- Left against medical advice (AMA)
- Reasons for leaving AMA
- Placement in treatment at time of discharge
Secondary Outcomes (explanation)
- Left against medical advice (AMA) - indicator for whether patient left AMA
- Reasons for leaving AMA - qualitative answers to questions about reasons for leaving AMA
- Placement in treatment at time of discharge - whether patient was admitted to a treatment program on discharge

Experimental Design

Experimental Design
Patients presenting for medically managed detox from fentanyl will be randomized to coverage of a standard detox stay or and extend length of stay.
Experimental Design Details
Not available
Randomization Method
Done by research team on a computer with sequence of randomization provided to intake coordinator
Randomization Unit
Patient
Was the treatment clustered?
No

Experiment Characteristics

Sample size: planned number of clusters
0 clusters
Sample size: planned number of observations
400
Sample size (or number of clusters) by treatment arms
200
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
MDE: 0.492 days increase in length of stay. This assumes 5% alpha and 80% power with 200 observations peer arm and an average length of stay of 3.96 days for patients in medically managed detox.
Supporting Documents and Materials

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IRB

Institutional Review Boards (IRBs)

IRB Name
University of Southern California IRB
IRB Approval Date
2025-06-02
IRB Approval Number
UP-25-00427
Analysis Plan

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