Effectiveness of Atomized Methadone on the Buccal Mucosa in the Last Days of Life: An Innovative Delivery Route When Patients Can No Longer Swallow

Abstract

Background: Methadone is an effective long acting opioid analgesic used to manage nociceptive and neuropathic pain. Its unique lipophilic properties, absence of active metabolites and high volume of distribution allows for delivery routes that are distinct and innovative enabling patients uninterrupted and effective pain control in the last days of life. Objective: The purpose of this study was to explore the effectiveness and ease of administration of atomized methadone solution on the buccal mucosa when alternative routes including rectal and sublingual were seen as less desirable by families and health care providers in patients in the last days of life who could no longer swallow medications. Methods: The charts of thirty patients who took methadone solution at the end of life were retrospectively reviewed and data collected regarding the various transmucosal delivery routes used. Satisfaction questionnaires were completed by families and health care providers after death looking at the effectiveness of pain control and ease of administration when methadone solution was given sublingual, rectal or atomized on the buccal mucosa. Conclusion: All 30 patients remained on methadone solution until their death. Of the twenty-two patients (73%) who had methadone solution atomized buccally, one was switched to rectal administration due to bitter taste and one to sublingual due to family preference. All families surveyed reported that methadone solution was effective in controlling pain and easy to administer.