Addiction Treatment

Key Recommendations from the American Pain Society on the use of methadone for pain

·         Assess likelihood of patient adherence

·         Patient education regarding risk of cardiac arrhythmias, onset of action, and communicating to health care team about new prescription or nonprescription drugs

·         Baseline ECG in patients with risk for QTc prolongation (family history, drug-induced, or electrolyte abnormalities)

·         Follow up ECG

o   Within 2 to 4 weeks in those at risk or those with history of QTc prolongation

o   If total daily methadone dose > 30mg

o   If total daily methadone dose > 100mg

o   Signs of ventricular arrhythmia (palpitations, syncope, pre-syncope)

·         Methadone is contraindicated in patients with QTc >500ms

·         Address reversible causes of QTc prolongation before starting methadone when QTc is between 450 to 500

·         Methadone is initiated < 2.5mg every 8 hours in opioid naïve patients

·         Methadone is initiated < 40mg daily in opioid tolerant patients

·         Dose cannot be titrated up more than every 5 to 7 days

·         Assess adverse effects 3 to 5 days after initiation of methadone

·         Methadone should be avoided with benzodiazepine

Additional Definitions

·         Misuse – using medication other than as directed

·         Abuse – using a medication for nonmedical purpose (ex: getting high)

·         Aberrant behavior – departing from strict adherence to the prescribed plan of care

·         Addiction – impaired control over drug use, compulsive use, craving

·         Pseudoaddiction – untreated pain exhibit aberrant behavior, but resolves with adequate pain control

·         Dependence – withdrawal symptoms due to stopping or decreasing the drug

·         Tolerance – decreased effectiveness of drug over time. Higher doses needed to get same effect.

·         Diversion – using a drug for recreational purposes

·         Hyperalgesia – escalating doses of opioids results in increase in pain severity or change in pain quality

Additional Drugs

·         Treatment of opioid abuse - Naltrexone, methadone, and buprenorphine

·         Treatment of alcohol abuse - Naltrexone, acamprosate, and disulfiram

·         Treatment of tobacco addiction - Bupropion, varenicline

Source:

Pharmacy Times. Managing Opioid Medications for Pain Relief While Preventing Overdose, Diversion, and Misuse: The Role of the Pharmacist.

http://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction