Abstract
Dr. Dickerson’s comments are apropos in regard to the choice of opioids in the management of advanced cancer pain. Several issues are relevant to pharmaco-economics. The cost of opioids may not reflect the milligrams used. There is a greater dollar cost per milligram of modified-release oxycodone and per microgram of fentanyl than of modified-release morphine. Methadone costs are one-tenth those of modified-release morphine. The milligrams utilized in the United States may be more evenly distributed than is reflected in costs. There are several additional barriers to utilizing methadone as opposed to other potent opioids. Methadone has been associated with addiction therapy, and in the public’s mind with the risk of addiction. Secondly, there is a non-linear equianalgesia to morphine, which requires experience in prescribing. There are excellent guidelines available, which
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