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J Pain Symptom Manage. 2019 Sep 24. pii: S0885-3924(19)30563-9. doi: 10.1016/j.jpainsymman.2019.09.014. [Epub ahead of print]

Comparing Methadone Rotation to Consensus Opinion.

Author information

1
Department of Pharmacy Services, Michigan Medicine, Ann Arbor, Michigan, USA; University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA. Electronic address: mandsmit@med.umich.edu.
2
Department of Pharmacy Services, Michigan Medicine, Ann Arbor, Michigan, USA; University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA.
3
Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA; Department of Pediatrics, Ann Arbor, Michigan, USA.
4
Department of Family Medicine, Michigan Medicine, Ann Arbor, Michigan, USA.
5
Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA.

Abstract

CONTEXT:

Methadone is a complex but useful medication for pain management in palliative care. Recent expert opinions have been published on the safe and effective use of methadone.

OBJECTIVES:

To determine the success of methadone rotations and evaluate concordance with consensus recommendations by a palliative care consult service.

METHODS:

A retrospective study of methadone rotation practice by a palliative care consult service and outcomes for patients hospitalized between January 1, 2012 and December 31, 2018 at a single academic medical center. A successful rotation was defined as a 30% reduction in pain or as-needed medication use sustained for at least three consecutive days. Patient outcomes were compared with expert consensus recommendations.

RESULTS:

About 59 patients met the inclusion criteria. The study population was mostly Caucasian men and women of equal proportions who were started on methadone for inadequate pain control. Sixty-eight percent of patients were successfully rotated. Subjects who were rotated using a standardized protocol were six times more likely to have a successful rotation (odds ratio 6.28 [1.25-30.92]; P = 0.0238).

CONCLUSION:

The utilization of a standardized protocol was associated with better patient outcomes.

KEYWORDS:

Methadone rotation; guideline adherence; successful opioid rotation

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