Methadone and the hospice patient: prescribing trends in the home-care setting.
OBJECTIVE
To identify frequency and utilization patterns of methadone by hospice patients in the home-care setting.


METHODS
All hospice patients admitted to a North American palliative care specialty pharmacy and dispensed methadone from November 1, 2001 to October 31, 2002 were analyzed. We also analyzed all hospice patients dispensed long-acting opioids during that same time period.


METHODS
A retrospective analysis of the pharmacy database was performed for patients dispensed methadone. Data was compared to the long acting opioid cohort to be able to identify any difference in terminal diagnoses present, and the presence of neuropathic pain in both groups. Methadone daily dosage was also analyzed during this study.


RESULTS
Four hundred sixteen hospice patients were dispensed methadone over a twelve-month period of time. For comparison, 21,219 patients were prescribed a long-acting opioid preparation (sustained-release morphine, sustained-release oxycodone, or transdermal fentanyl). The most common terminal diagnosis for both groups was lung carcinoma. The distribution of terminal diagnoses was similar in both groups. The group prescribed methadone was found to have a higher incidence of neuropathic pain (30.5% of patients) when compared to the long-acting opioid group (16.9%). Most patients (61.3%) were prescribed daily methadone doses of 100 mg or less.


CONCLUSIONS
Despite its potential clinical and economic benefits, methadone is not commonly prescribed for the hospice patient in the home-care setting. Clinicians may be more aware of the usefulness of methadone in the treatment of neuropathic pain.
Weschules
Douglas J
DJ
ExcelleRx Institute, Philadelphia, Pennsylvania 19106, USA. dweschules@excellerx.com
McMath
Jill A
JA
Gallagher
Rollin
R
Alt
Calvin J
CJ
Knowlton
Calvin H
CH
D000701:Analgesics, Opioid / Q000627:therapeutic use*; D011307:Drug Prescriptions; D004363:Drug Utilization / Q000639:trends*; D005260:Female; D006699:Home Care Services / Q000639:trends*; D017051:Hospice Care / Q000639:trends*; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D009369:Neoplasms / Q000503:physiopathology; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010166:Palliative Care / Q000639:trends; D012189:Retrospective Studies
D000701:Analgesics, Opioid; D008691:Methadone