Methadone Safety: Clinical Practice Guidelines from the American Pain Society and College on Problems of Drug Dependence

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By Roger Chou, MD
Associate Professor of Medicine, Oregon Health & Science University, Director, the Pacific Northwest Evidence-based Practice Center

Module Description: Methadone is a synthetic opioid used to treat chronic pain and opioid addiction. Safety of methadone has been a major clinical concern in recent years. Deaths associated with methadone use increased from 800 in 1999 to 4,900 in 2008. The increase in mortality is larger than for any other opioid medication, and is largely attributed to a sharp rise in prescribing methadone for chronic pain. Methadone has properties that increase risk for serious adverse events, including a long and variable half-life, potential for electrocardiographic QTc interval prolongation and associated cardiac arrhythmias, multiple drug-drug interactions, and dose conversion ratios from other opioids that vary at different doses. The American Pain Society and College on Problems of Drug Dependence issues guidelines on methadone safety in 2014 to improve methadone safety. This presentation reviews evidence on methadone safety, properties of methadone, and recommendations for safer use, include careful patient assessment, use of alternative opioids and treatments, education and counseling, use of ECG screening and monitoring, careful dose initiation and titration, careful monitoring and follow-up, and use of risk mitigation strategies.

Note: This online module is not designated for AMA PRA Category 1 Credit™.