Evaluation of a pharmacist-managed methadone taper*.
OBJECTIVE
To evaluate the efficacy of a pharmacist-managed methadone taper as compared to previous prescribing practices.


METHODS
Retrospective chart review with comparison to historical controls.


METHODS
Ninety-six-bed pediatric quaternary care facility with the majority of the patients in a 24-bed ICU.


METHODS
Thirty-two patients, 1 month to 16 years old, weaned off opioids using methadone prior to protocol initiation were compared with 20 patients, 1 month to 15 years old, weaned per the pharmacist-managed methadone taper protocol.


METHODS
Implementation of a pharmacist-managed methadone tapering protocol.


RESULTS
Patient age, gender, weight, and risk of withdrawal were similar between the groups (p = not significant). The average taper length before pharmacist intervention was 24.7 days; after implementation it was 15 days (p = 0.0026). There was no statistical difference in the number of additional doses of opioid required or withdrawal scores between the populations. Opioid infusions were stopped, on average, 1.54 days sooner in the intervention group (p = 0.0039). A decrease in hospital length of stay was also seen in the intervention group (p = 0.023).


CONCLUSIONS
A pharmacist-managed protocolized methadone taper facilitates discontinuing methadone sooner, discontinuing additional opioid infusions sooner, and may impact on the length of hospital stay. The protocol developed at the University of Minnesota Amplatz Children's Hospital has demonstrated that it is an effective method to wean pediatric patients from opioids.
1Department of Pharmacy, University of Minnesota Amplatz Children's Hospital, Minneapolis, MN. 2Department of Pharmacy, University of Minnesota Medical Center, Minneapolis, MN. 3Division of Pediatric Critical Care Medicine, University of Minnesota Amplatz Children's Hospital, Minneapolis, MN.
Katherine J
KJ
Steineck
Angela K
AK
Skoglund
Melissa K
MK
Carlson
Sameer
S
Gupta
D000293:Adolescent; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008297:Male; D008691:Methadone / Q000008:administration & dosage*; D008910:Minnesota; D009293:Opioid-Related Disorders / Q000628:therapy*; D010595:Pharmacists; D012189:Retrospective Studies; D013375:Substance Withdrawal Syndrome / Q000628:therapy*
D000701:Analgesics, Opioid; D008691:Methadone