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Emergency Department Impact Spotlight

University of Mary​land Medical Center: Using the DEA 3-Day Rule to Ensure Treatment Continuity​​​

Published
August 31, 2026
Facility
University of Maryland Medical Center
Region
Central Maryland
Featuring
Dr. Malik Burnett, Medical Director & Adjunct Professor, UMMC

Tagged

  • Baltimore City
  • Initiation/continuation of addiction medications
  • Linkage to ongoing SUD care​

Inclusion is not an endorsement

The Maryland Department of Health shares this account to highlight practices other facilities may find useful. Appearing in this series is not an endorsement, recommendation, certification, or approval of any hospital, health system, provider, vendor, or program by the Maryland Department of Health or the State of Maryland. Descriptions and figures are provided by the participating facility.

“Recovery is not rare. With the right plan, support, and clinical infrastructure, recovery is imminently achievable.”

— Dr. Malik Burnett, Medical Director

The University of Maryland Medical Center (UMMC) operates a comprehensive, hospital-based model for substance use disorder (SUD) care, rooted in clinical standardization, a robust referral system, and continuing education on best practices. By transitioning SUD care from a specialty to a core medical service, UMMC has successfully integrated evidence-based treatment throughout its health system. This framework ensures that care is accessible in the emergency department, inpatient units, and outpatient addiction and opioid treatment programs.​

According to Dr. Malik Burnett, medical director and adjunct professor of addiction medicine, UMMC’s success is a result of its long-standing institutional commitment to addiction medicine. The system embedded substance use disorder treatment into its clinical and academic culture well before his arrival six years ago, and has continued refining its approach as standards of care evolve. This foundation allows providers across the system to manage patients receiving medications for opioid use disorder with greater consistency, whether they present in the emergency department (ED) for an overdose, are admitted for a medical condition, or need connection to outpatient care.​​

Varied Treatment Pathways

A central strength of UMMC’s model is their varied treatment pathways. The emergency department has an established framework for initiating buprenorphine, and the system more recently expanded access to methadone under the Drug Enforcement Administration (DEA) three-day rule. This allows UMMC hospitals to provide methadone for up to 72 hours for eligible patients presenting to the ED or leaving the hospital, creating a critical bridge back to community-based opioid treatment. Dr. Burnett emphasized that the ability to offer both buprenorphine and methadone in nearly any care setting across the University of Maryland hospital system represents an important advancement for patients statewide.​​​​

Closing the Methadone-Verification Gap

UMMC also addressed an ongoing hospital-based barrier: continuing methadone for patients already enrolled in opioid treatment programs. Because methadone dispensing data are not available through Maryland’s Prescription Drug Monitoring Program, clinicians can face delays when verifying outpatient doses, particularly on nights and weekends. UMMC developed a protocol requiring staff to make documented efforts to contact the patient’s opioid treatment program, verify the dose, and continue treatment. If the dose cannot be verified, clinicians can start methadone using a defined protocol and proceed based on clinical symptoms. This prevents patients from being left untreated, experiencing withdrawal, or having their broader medical care undermined.

A Patient-Centered Linkage Model
UMMC’s model is patient-centered. In Baltimore City, where patients have multiple treatment options, UMMC does not rely on a single formal referral partner. Instead, peer recovery specialists and providers use their relationships with community-based programs to connect patients to care near where they live. Dr. Burnett emphasized that proximity matters: a technically appropriate referral is less useful if transportation makes follow-up unrealistic.

For other hospitals seeking to improve substance use disorder outcomes, Dr. Burnett’s advice is to start by listening to the people being served. Asking patients what they need fosters a relationship of mutual respect and understanding. Institutional trust is rebuilt in little moments like these.

UMMC’s story models that effective hospital-based overdose response does not depend on a single program or heroic individual. It depends on building a system where evidence-based care is expected, protocols are clear, and patients are connected to the services most likely to work in their daily lives. As Dr. Burnett put it, recovery is not rare. With the right plan, support, and clinical infrastructure, recovery is “imminently achievable.”​​

By the numbers

  • 72 hoursmethadone now bridgeable in the ED under the DEA three-day rule
  • 2medications — buprenorphine and methadone — offered in nearly any care setting
  • 6 yearsof continued refinement since Dr. Burnett joined an already-committed system

Figures reflect what the interviewee reported and are provided by the participating facility.

What other Maryland hospitals can take away

  • Make SUD care a core medical service, not a specialty carve-out, so it’s available in the ED, inpatient, and outpatient alike.
  • Use the DEA three-day rule to bridge methadone for up to 72 hours and prevent gaps back to community treatment.
  • Write a verification protocol for continuing methadone when PDMP data isn’t available — don’t leave patients in withdrawal.
  • Start by listening to the people being served; proximity and daily-life realities decide whether a referral works.
  • The throughline: clear protocols and expected, evidence-based care matter more than any single heroic individual.

More impact spotlights

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The Overdose Data to Action team is interviewing emergency department clinicians and peer recovery specialists across Maryland.

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Questions? Contact the Overdose Data to Action team at [email protected]. Submitting the form does not guarantee inclusion, and inclusion is not an endorsement by the Maryland Department of Health.

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