Methadone as an analgesic: a review of the risks and benefits.
While methadone has been available for over 50 years, its use in opiate dependence has overshadowed its use as an analgesic. Within the last 10-15 years, though, methadone has been increasingly used to manage neuoropathic pain and cancer pain, but its use is causing an alarming number of deaths in the U.S. Last June, The Charleston Gazette ran a series titled "The Killer Cure" by Scott Finn and Tara Tuckwiller that found that the number of Americans whose deaths were caused by methadone rose from 790 in 1999 to 2,992 in 2003. The series also reported other statistics from the National Center for Health Statistics that revealed that West Virginia ranked first per capita in methadone overdose deaths, and that methadone was more likely involved in overdose deaths than any other prescription drug. Methadone has several unique properties that can be beneficial in the treatment of neuropathic pain and cancer pain unresponsive to other opioids, but some of these properties make it very dangerous and difficult to prescribe properly. As a result of these factors, methadone should not be the first-choice drug for pain and it should not be used in opioid-naive patients. The goal of this article is to provide a review of the properties and protocols for safe prescribing of methadone to help physicians recognize situations where this drug offers the greatest advantage as an analgesic.
Terpening
Chris M
CM
Dept. of Family Medicine, West Virginia University School of Medicine, Charleston Division, USA.
Johnson
W Michael
WM
D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004347:Drug Interactions; D006801:Humans; D008691:Methadone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy*; D018570:Risk Assessment
D000701:Analgesics, Opioid; D008691:Methadone