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METHADONE
for pain
GUIDELINES
Facilitated by the College of Physicians and Surgeons of OntarioNovember 2004
These guidelines are in effect as of November 2004.This document may be reprinted and distributed in its entirety for non-commercial purposes without permission,but permission must be obtained to edit its content.College of Physicians and Surgeons of Ontario80 College Street, Toronto, Ontario, Canada M5G 2E2Telephone: (416) 967-2661
Table of Contents
Preface/Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3Scope and Purpose. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4The Pharmacology of Methadone. . . . . . . . . . . . . . . . . . . . . . . .5Methadone Maintenance Treatment (MMT) for Opioid Addiction. . .5Methadone for Chronic Pain Management. . . . . . . . . . . . . . . . . .7Group I: Primary Pain patients. . . . . . . . . . . . . . . . . . . . . . . .7Group II:
Pain patients with past or active substance dependence
. .7Group III: Pain patients with concurrent opioid addiction. . . .8Using Methadone to Treat Pain. . . . . . . . . . . . . . . . . . . . . . . . . .9 Assessment Phase. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9Treatment Phase. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10Informed Consent/Treatment Agreements. . . . . . . . . . . . . .11Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11Specific Cautions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12The Role of Family and Supportive Others. . . . . . . . . . . . . .12Misuse/Diversion of Methadone. . . . . . . . . . . . . . . . . . . . . .13Documentation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13Methadone Dosing in the Management of Pain. . . . . . . . . . . . .13Prescribing and Dispensing. . . . . . . . . . . . . . . . . . . . . . . . .14General Considerations. . . . . . . . . . . . . . . . . . . . . . . . . .14Methadone Availability. . . . . . . . . . . . . . . . . . . . . . . . . .14Opioid Naïve Patients. . . . . . . . . . . . . . . . . . . . . . . . . . .16Changing to Methadone. . . . . . . . . . . . . . . . . . . . . . . . .17 Withdrawal Mediated Pain. . . . . . . . . . . . . . . . . . . . . . . . . . . .181
METHADONE
for pain
GUIDELINES
Sections
« prev | next »- Preface/Introduction
- Scope and Purpose
- The Pharmacology of Methadone
- Methadone Maintenance Treatment (MMT) for Opioid Addiction
- Methadone for Chronic Pain Management
- Group I: Primary Pain patients
- Group II: Pain patients with past or active substance dependence
- Group III: Pain patients with concurrent opioid addiction
- Using Methadone to Treat Pain
- Assessment Phase
- Treatment Phase
- Informed Consent/Treatment Agreements
- Monitoring
- Specific Cautions
- The Role of Family and Supportive Others
- Misuse/Diversion of Methadone
- Documentation
- Methadone Dosing in the Management of Pain
- Prescribing and Dispensing
- General Considerations
- Methadone Availability
- Opioid Naïve Patients
- Changing to Methadone
- Withdrawal Mediated Pain
- Using Methadone to Assess Opioid Responsiveness
- Special Considerations
- Optimal Dose
- Vomited Doses
- Missed Doses and Loss of Tolerance
- Methadone Drug Interactions
- Managing Acute Pain in Patients on Methadone
- Obtaining a Methadone Exemption
- The Pharmacist and Methadone Dispensing for Pain Management
- Urine Drug Testing
- Methadone Withdrawal
- Therapeutic Taper
- Administrative Taper
- Managing Patients with Pain and Addictive Disorders
- References
- Suggested Readings
- Appendix A
- Appendix B
- Appendix C
- Appendix D
- Appendix E
- Appendix F
- Appendix G
- Appendix H
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