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.
2
This guideline mirrors a previously published cardiac safety guideline in 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.
J Pain. 2014; 15: 321-337
5
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
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References
- Evaluation of the dofetilide risk-management program.Am Heart J. 2003; 146: 894-901
- 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
- QTc Interval Screening in an Opiod Treatment Program.Am J Cardiol. 2013; 112: 1013-1018
- Treating opioid dependence: Growing implications for primary care.Arch Int Med. 2004; 164: 277-288
- QTc interval screening in methadone treatment.Ann Intern Med. 2009; 150: 3887-3895
Article info
Footnotes
M.J.K. holds a consulting relationship with Cardiocore.
The authors report no conflicts of interest.
Identification
Copyright
© 2014 American Pain Society. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Response to Katz and Krantz Letter to the EditorThe Journal of PainVol. 15Issue 9
- PreviewThank 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.
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