Is
it safe to prescribe opioid analgesics to methadone patients?
What
information does a patient's methadone clinic need about
his/her outpatient medical treatment?
Is
it appropriate to prescribe benzodiazepines to methadone
patients?
Do
any special arrangements need to be made for the
inpatient care of a methadone patient?
Yes. Patients on a stable dose of
methadone develop nearly complete tolerance to the
analgesic, sedative, and euphorigenic effects of
methadone. They receive no pain relief from their
regular, daily methadone dose. Adequate pain
control requires maintaining a patient's establishing
tolerance threshold with methadone at the usual dose,
then providing additional analgesia.
Non-narcotic analgesics should be used
when pain is not severe. In the event of more severe
pain, it is appropriate to use opioid agonist
medication. The dose of an opioid-agonist may need
to be increased because of cross-tolerance to methadone.
Also, the duration of analgesia may be less than
usual.
It is very important to avoid using
mixed agonist-antagonist medications such as pentazocine
(Talwin), butorphanol tartrate (Stadol) and nalbuphine
hydrocholride (Nubain). Severe opiate abstinence
syndrome can be precipitated by this type of medication.
(Back to Top)
The clinic will need verification of the
patient's diagnosis, prescribed medication, and any
medication administered directly to the patient.
(Back to Top)
Generally, no. In accordance with the American
Psychiatric Association's practice
guideline for the treatment of panic disorder,
we strongly discourage the use of benzodiazepines by our
patients. Iatrogenic complications from use of
this class of medication are very common among methadone
patients. We commonly see marked functional
deterioration (frequent intoxication, impaired
judgement, disorientation, etc) in patients being
treated with benzodiazepines, even when the medication
was prescribed for legitimate reasons.
There are, however, some methadone
patients who do benefit from benzodiazepine therapy. For
this reason, we do not arbitrarily ban the use of
prescribed benzodiazepines. But we do ask that
their use be coordinated with the clinic's medical
staff. The patient's medical provider would need
the following information in order to determine whether
the benefits of benzodiazepine therapy outweigh the
risks in light of the patient's participation in opioid
therapy:
Questions about these procedures should
be directed to the patient's ETS medical provider.
(Back to Top)
Do any special arrangements need to be
made for the inpatient care of a
methadone patient?
When a methadone patient enters the
hospital, medical staff need to contact the clinic to
verify the patient's current methadone dose.
Upon discharge, the patient should be
provided with documentation showing:
Review
Article