Advertisement

Methadone Safety Guidelines: A New Care Delivery Paradigm

      We applaud the recently published Methadone Safety Guidelines by Chou and colleagues for its comprehensive approach to ensuring patient safety during both initiation and maintenance phases of methadone treatment.
      • Chou R.
      • Cruciani R.A.
      • Fiellin D.A.
      • Compton P.
      • Farrar J.T.
      • Haigney M.C.
      • Inturrisi C.
      • Knight J.R.
      • Otis-Green S.
      • Marcus S.M.
      • Mehta D.
      • Meyer M.C.
      • Portenoy R.
      • Savage S.
      • Walsh S.
      • Zeltzer L.
      Methadone safety: A clinical practice guideline from the American Pain Society and College on problems of drug dependence, in collaboration with the Heart Rhythm Society.
      This guideline mirrors a previously published cardiac safety guideline in methadone treatment
      • Krantz M.J.
      • Martin J.
      • Stimmel B.
      • Mehta D.
      • Haigney M.C.
      QTc interval screening in methadone treatment.
      focused on prolongation of the QTc interval and extends its focus to mitigation of the risks of respiratory depression and opioid misuse via routine urine drug testing. This is increasingly relevant since the distinction between opioid treatment for chronic pain and opioid dependency is not always clear in clinical practice. Most importantly, the directive to “start low and go slow” with regard to dose titration has the potential to limit the growing number of unintentional fatalities associated with methadone.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Pain
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Allen LaPointe N.M.
        • Chen A.
        • Hammill B.
        • DeLong E.
        • Kramer J.M.
        • Califf R.M.
        Evaluation of the dofetilide risk-management program.
        Am Heart J. 2003; 146: 894-901
        • Chou R.
        • Cruciani R.A.
        • Fiellin D.A.
        • Compton P.
        • Farrar J.T.
        • Haigney M.C.
        • Inturrisi C.
        • Knight J.R.
        • Otis-Green S.
        • Marcus S.M.
        • Mehta D.
        • Meyer M.C.
        • Portenoy R.
        • Savage S.
        • Walsh S.
        • Zeltzer L.
        Methadone safety: A clinical practice guideline from the American Pain Society and College on problems of drug dependence, in collaboration with the Heart Rhythm Society.
        J Pain. 2014; 15: 321-337
        • Katz D.F.
        • Sun J.
        • Khatri V.
        • Kao D.
        • Bucher-Bartelson B.
        • Traut C.
        • Lundin-Martinez J.
        • Goodman M.
        • Mehler P.S.
        • Krantz M.J.
        QTc Interval Screening in an Opiod Treatment Program.
        Am J Cardiol. 2013; 112: 1013-1018
        • Krantz M.J.
        • Mehler P.S.
        Treating opioid dependence: Growing implications for primary care.
        Arch Int Med. 2004; 164: 277-288
        • Krantz M.J.
        • Martin J.
        • Stimmel B.
        • Mehta D.
        • Haigney M.C.
        QTc interval screening in methadone treatment.
        Ann Intern Med. 2009; 150: 3887-3895

      Linked Article

      • Response to Katz and Krantz Letter to the Editor
        The Journal of PainVol. 15Issue 9
        • Preview
          Thank you for the comments regarding the methadone safety guideline from the American Pain Society and College on Problems of Drug Dependence.1 Regarding the strength of evidence, in situations involving patient safety, clinical practice guideline recommendations and other policy decisions frequently must be made on the basis of limited evidence. For example, black box warnings issued by the Food and Drug Administration and drug withdrawals are often based primarily on case reports of serious adverse events,3 and recommendations regarding laboratory monitoring for many medications (eg, monitoring patients started on angiotensin-converting enzyme inhibitors for hyperkalemia) are primarily based on the potential for detecting adverse events, rather than on direct evidence that such efforts reduce harms.
        • Full-Text
        • PDF