Is Methadone a Viable Option for Pain Control?
As healthcare professionals, we have all cared for patients with pain issues in one way or another. Ensuring our patients receive effective pain management – regardless of the basis of that pain or even what issues the patient has had in the past including past misuse or abuse – is critical.
Today, there are many different drugs, drug combinations, non-pharmaceutical and nonconventional treatment modalities that can be considered, depending on a patient’s specific condition. The difficulty lies in determining which is the “best” choice for the patient.
One medication option that is being utilized more frequently is methadone. This drug is becoming a very popular choice for the treatment of pain not only in hospice and palliative care, but for patients with chronic and/or complex pain issues.
Methadone was commonly known for its use for patients with addiction to and to ease the agony associated with heroin and opioid withdrawal. The drug was somewhat effective in helping those with a drug addition to taper off, and eventually, stop using opioids. Now, it’s becoming more mainstream in pain management.
There are various reasons methadone is now becoming more accepted by prescribing physicians for pain use in pain management. One reason is that methadone has less potential for abuse because the drug creates less of a “high” or feeling of euphoria than other opiates such as oxycodone, hydrocodone, or hydromorphone.
Another reason is that it is more cost effective than many of the other drugs on the market. For example, based on an internet pharmacy comparison site, they showed that 60 tablets of oxycodone at a well-known neighborhood chain pharmacy were listed at $167.22. However, this same pharmacy listed 90 tablets of methadone for $16.21.
What are the risks of methadone?
Since methadone is a synthetic opioid antagonist with a diphenylheptane structure, its mu receptor is more like morphine. Due to the drug composition, many experts feel that methadone is more effective than other opioids on the market today, especially for neuropathic pain syndromes.
Methadone use, as with any drug, comes with known risks if not properly prescribed and closely monitored by qualified healthcare professionals. Dosing can be very idiosyncratic due to the accumulation of metabolites in the first 10 days to two weeks after beginning the drug.
Unlike some drugs, the analgesic effects are not generally immediate and the patient will experience better pain control as time progresses. This can increase the potential that a patient experiencing pain may increase the dose or take more than prescribed to self-medicate. This can cause some profound adverse effects, such as respiratory depression, lethargy, and increased somnolence, especially in patients that are opioid naïve.
In hospice, a methadone protocol is recommended. This protocol should include helping patients understand that methadone should be used as one aspect of a comprehensive pain management regimen. It also must ensure that the prescriber, the staff, and ultimately the patient and caregiver understand the drug, it’s adverse effects, what to report and when, and to never increase the dose without physician directive and oversight. The prescriber and the nurses monitoring the patient must also understand that dose titration should occur after a minimum of 5 days in most cases. Increasing the dose too quickly can lead to unwarranted side effects and complications.
Even with the potential adverse effects, methadone in the hospice and palliative care setting remains relatively safe, and highly effective, when prescribed and monitored closely.
Understanding what methadone does is critical in ensuring the patient and their family experience a comfortable disease progression and, ultimately, a pain-free dying process. This can be effectively managed when the hospice and palliative care medical director or physician understand the drug, its benefits, side effects and dosing parameters.
If you need more information on methadone use for pain management in hospice, contact Crossroads Hospice and Palliative Care at 1-888-564-3405
DeAnna Looper RN, CHPN, CHPCA, LNC
Senior Vice President of Clinical Operations
Crossroads Hospice & Palliative Care
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