Comparing Methadone Rotation to Consensus Opinion

Abstract

ContextMethadone is a complex but useful medication for pain management in palliative care. Recent expert opinions have been published on the safe and effective use of methadone. ObjectivesTo determine the success of methadone rotations and evaluate concordance with consensus recommendations by a palliative care consult service. MethodsA retrospective study of methadone rotation practice by a palliative care consult service and outcomes for patients hospitalized between January 1, 2012 and December 31, 2018 at a single academic medical center. A successful rotation was defined as a 30% reduction in pain or as-needed medication use sustained for at least three consecutive days. Patient outcomes were compared with expert consensus recommendations. ResultsAbout 59 patients met the inclusion criteria. The study population was mostly Caucasian men and women of equal proportions who were started on methadone for inadequate pain control. Sixty-eight percent of patients were successfully rotated. Subjects who were rotated using a standardized protocol were six times more likely to have a successful rotation (odds ratio 6.28 [1.25–30.92]; P = 0.0238). ConclusionThe utilization of a standardized protocol was associated with better patient outcomes.