Methadone Pain Management


In the US, methadone pain management is a relatively new phenomenon. Although the drug has been available for doctors to prescribe since the 1970s, it has only gained popularity for chronic pain management in the last decade. Before that, methadone was primarily used to treat heroin addiction – it has the attribute of being able to stave off cravings for a day or more in heroin addicts.

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While methadone pain management is effective, relatively safe and cheaper than alternatives, it is not without risk. As the popularity grew, the number of methadone related overdoses and deaths also jumped up. The GAO reported to congress that since 1999, deaths associated with methadone use have more than tripled in the United States (2006 data). It is not known if this is a result of more prescriptions, misuse or dangers inherent in the drug. There is also concern that more prescriptions for methadone pain management has allowed methadone to become available for illegal use as well.

Most often, methadone pain management is for cancer patients and the terminally ill for chronic pain management. Besides its low cost, it lasts longer than morphine and can be given to patients without regard to kidney function (a common associated malady). The problems with the drug come from its odd pharmacological properties and patients who may not understand exactly how to take it.

The main advantage of methadone pain management is also a disadvantage when it is misused. Briefly, the drug builds up in the body and tissues act as a reservoir. This means that the dose taken may not reflect the amount of drug “on board.” Patients cannot simply increase the dose to get more relief because they then risk overdose without being aware of it. Added to this is the risk of mixing other central nervous system depressants, such as benzodiazepines (for depression or sleep) and alcohol. Because the drug stays around so long (72 hours or more) – even though the pain relieving effects may have diminished, adding another depressant drug can have serious consequences.

There is also the increased withdrawal time needed if a patient has to stop taking methadone. One cannot simply stop methadone and start morphine (as an example). Careful lowering of the dose is needed.

The best use of methadone pain management is then in the case of a stable, long term, chronic pain where other, safer opiates have been tried but do not give enough relief. Patients and caregivers have to understand the risks and the correct dosing patterns for the drug as well.

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