Safe and Appropriate Use of Methadone in Hospice and Palliative Care: Expert Consensus White Paper

Mary Lynn McPherson; Kathryn A Walker; Mellar P Davis; Eduardo Bruera; Akhila Reddy; Judith Paice; Kasey Malotte; Dawn Kashelle Lockman; Charles Wellman; Shelley Salpeter; Nina M Bemben; James B Ray; Bernard J Lapointe; Roger Chou

doi:10.1016/j.jpainsymman.2018.12.001

Safe and Appropriate Use of Methadone in Hospice and Palliative Care: Expert Consensus White Paper

J Pain Symptom Manage. 2019 Mar;57(3):635-645.e4. doi: 10.1016/j.jpainsymman.2018.12.001. Epub 2018 Dec 20.

Authors

Affiliations

¹ University of Maryland School of Pharmacy, Baltimore, Maryland, USA. Electronic address: [email protected].
² University of Maryland School of Pharmacy, Baltimore, Maryland, USA; MedStar Health, Baltimore, Maryland, USA.
³ Geisinger Medical Center, Danville, Philadelphia, USA.
⁴ Palliative, Rehabilitation & Integrative Medicine Department, University of Texas MD Anderson Cancer Center, Houston, Texas, USA; F. T. McGraw Chair in the Treatment of Cancer, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
⁵ The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
⁶ Division of Hematology-Oncology, Northwestern University, Chicago, Illinois, USA; Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
⁷ Advanced Practice Pharmacist Supportive Care Medicine Cedars-Sinai Medical Center, Los Angeles, California, USA.
⁸ Hospice & Palliative Care, University of Iowa College of Pharmacy, Iowa City, Iowa, USA; Internal Medicine-Palliative Care Program, Iowa City, Iowa, USA.
⁹ Hospice of the Western Reserve, Cleveland, Ohio, USA.
¹⁰ Stanford University School of Medicine, Stanford, California, USA; Mission Hospice and Home Care, San Mateo, California, USA.
¹¹ Wolters Kluwer, Chicago, Illinois, USA.
¹² University of Iowa College of Pharmacy, Iowa City, Iowa, USA; Supportive and Palliative Care Consult Service, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
¹³ Eric M. Flanders Chair in Palliative Medicine, McGill University, Montreal, Canada; Chief Supportive and Palliative Care Division, Jewish General Hospital, Montreal, Canada.
¹⁴ Division of General Internal Medicine and Geriatrics, OHSU, USA.

PMID: 30578934
DOI: 10.1016/j.jpainsymman.2018.12.001

Abstract

Methadone has several unique characteristics that make it an attractive option for pain relief in serious illness, but the safety of methadone has been called into question after reports of a disproportionate increase in opioid-induced deaths in recent years. The American Pain Society, College on Problems of Drug Dependence, and the Heart Rhythm Society collaborated to issue guidelines on best practices to maximize methadone safety and efficacy, but guidelines for the end-of-life scenario have not yet been developed. A panel of 15 interprofessional hospice and palliative care experts from the U.S. and Canada convened in February 2015 to evaluate the American Pain Society methadone recommendations for applicability in the hospice and palliative care setting. The goal was to develop guidelines for safe and effective management of methadone therapy in hospice and palliative care. This article represents the consensus opinion of the hospice and palliative care experts for methadone use at end of life, including guidance on appropriate candidates for methadone, detail in dosing, titration, and monitoring of patients' response to methadone therapy.

Keywords: Methadone; arrhythmias; hospice; medication safety; palliative care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Analgesics, Opioid / adverse effects
Analgesics, Opioid / therapeutic use*
Hospice Care*
Humans
Methadone / adverse effects
Methadone / therapeutic use*
Pain / drug therapy*
Palliative Care*

Substances

Analgesics, Opioid
Methadone