title: Safe methadone induction and stabilization: report of an expert panel.
abstract: OBJECTIVE
  Methadone is a well-studied, safe, and effective medication when dispensed and consumed properly. However, a number of studies have identified elevated rates of overdose and death in patients being treated with methadone for either addiction or chronic pain. Among patients being treated with methadone in federally certified opioid treatment programs, deaths most often occur during the induction and stabilization phases of treatment. To address this issue, the federal Substance Abuse and Mental Health Services Administration invited the American Society of Addiction Medicine to convene an expert panel to develop a consensus statement on methadone induction and stabilization, with recommendations to reduce the risk of patient overdose or death related to methadone maintenance treatment of addiction.
  
  
  METHODS
  A comprehensive literature search of English-language publications (1979-2011) was conducted via MEDLINE and EMBASE. Methadone Action Group members evaluated the resulting information and collaborated in formulating the consensus statement presented here, which subsequently was reviewed by more than 100 experts in the field.
  
  
  RESULTS
  Published data indicate that deaths during methadone induction occur because the initial dose is too high, the dose is increased too rapidly, or the prescribed methadone interacts with another drug. Therefore, the Methadone Action Group has developed recommendations to help methadone providers avoid or minimize these risks.
  
  
  CONCLUSIONS
  Careful management of methadone induction and stabilization, coupled with patient education and increased clinical vigilance, can save lives in this vulnerable patient population.
authors.affiliation: From the Methadone Action Group (LEB), American Society of Addiction Medicine, Chevy Chase, MD; Professional Assistance Program of New Jersey (LEB) and University of Medicine and Dentistry of New Jersey (LEB), Princeton; US Public Health Service (AC), and Division of Pharmacologic Therapies (AC), Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, MD; Medical Affairs (MD), Camden County Health Service Center, Blackwood, NJ; Department of Psychiatry (PL), University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark; Community Behavioral Health Services (JAM) and Substance Abuse Services (JAM), Department of Public Health, City and County of San Francisco, CA; Department of Psychiatry (LM), University of Pennsylvania School of Medicine, Philadelphia; and Behavioral Health (LM), Philadelphia VA Medical Center, Philadelphia, PA; Colonial Management Group, LP (JTP), Wimberly, TX; Albert Einstein Medical Center (EAS) and Beth Israel Medical Center (EAS), New York, NY; JEVS Human Services (TT), Philadelphia, PA; and Center for Health Services and Outcomes Research (BBW), JBS International, Inc, Easton, MD.
authors.forename: Louis E
authors.initials: LE
authors.lastname: Baxter
authors.forename: Anthony
authors.initials: A
authors.lastname: Campbell
authors.forename: Michael
authors.initials: M
authors.lastname: Deshields
authors.forename: Petros
authors.initials: P
authors.lastname: Levounis
authors.forename: Judith A
authors.initials: JA
authors.lastname: Martin
authors.forename: Laura
authors.initials: L
authors.lastname: McNicholas
authors.forename: J Thomas
authors.initials: JT
authors.lastname: Payte
authors.forename: Edwin A
authors.initials: EA
authors.lastname: Salsitz
authors.forename: Trusandra
authors.initials: T
authors.lastname: Taylor
authors.forename: Bonnie B
authors.initials: BB
authors.lastname: Wilford
mesh_terms: D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring; D062787:Drug Overdose / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D060828:Induction Chemotherapy / Q000009:adverse effects / Q000379:methods; D054539:Medication Therapy Management; D008691:Methadone / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D009293:Opioid-Related Disorders / Q000628:therapy*; D010353:Patient Education as Topic; D020379:Risk Adjustment
chemical_list: D008691:Methadone