Morphine to Methadone Conversion: An Interpretation of Published Data

Pollock, Ashley B.; Tegeler, Monica L.; Morgan, Vickie; Baumrucker, Steven J.

doi:10.1177/1049909110373508

Cited by 33 publications

(23 citation statements)

References 29 publications

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“…29 The AL method has been recommended on the basis of expert opinion, 31 but there is currently no consensus, based on empirical research, as to what is the safest and most effective method for rotation to methadone from other strong opioids. 32,33 The objectives of this review were to define the available evidence with regard to methods of rotation to methadone and to determine if sufficient evidence exists regarding the superiority (effectiveness and safety) of one method over others.…”

Section: Introductionmentioning

confidence: 99%

Methods of Rotation From Another Strong Opioid to Methadone for the Management of Cancer Pain: A Systematic Review of the Available Evidence

McLean¹,

Twomey

2015

Journal of Pain and Symptom Management

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Section: Introductionmentioning

confidence: 99%

Methods of Rotation From Another Strong Opioid to Methadone for the Management of Cancer Pain: A Systematic Review of the Available Evidence

McLean¹,

Twomey

2015

Journal of Pain and Symptom Management

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“…Proposed equianalgesic dose ratios for conversion of other opioids (in mg morphine equivalents) to methadone are variable and range from 3:1 to 10:1 at lower doses to 8:1 to 20:1 at higher doses. 78 In patients on lower doses of other opioids (eg, <40-60 mg morphine equivalents/ d), the panel suggests starting methadone at doses similar to those recommended for opioid-na€ ıve patients. For patients on higher doses of other opioids, the panel suggests that clinicians start methadone at a dose 75 to 90% less than the calculated equianalgesic dose, based on more conservative dosing ratios (eg, 15:1 to 20:1) and at no higher than 30 to 40 mg/ d.…”

Section: Initiation Of Methadonementioning

confidence: 99%

Methadone Safety: A Clinical Practice Guideline From the American Pain Society and College on Problems of Drug Dependence, in Collaboration With the Heart Rhythm Society

Chou

Cruciani

Fiellin

et al. 2014

The Journal of Pain

206

188

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Methadone is used for the treatment of opioid addiction and for treatment of chronic pain. The safety of methadone has been called into question by data indicating a large increase in the number of methadone-associated overdose deaths in recent years that has occurred in parallel with a dramatic rise in the use of methadone for chronic pain. The American Pain Society and the College on Problems of Drug Dependence, in collaboration with the Heart Rhythm Society, commissioned an interdisciplinary expert panel to develop a clinical practice guideline on safer prescribing of methadone for treatment of opioid addiction and chronic pain. As part of the guideline development process, the American Pain Society commissioned a systematic review of various aspects related Clinical practice guidelines are ''guides'' only and may not apply to all patients and all clinical situations. As part of a shared decision-making approach, it may be appropriate for the clinician to inform a patient that a particular recommendation may not be applicable, after considering all circumstances pertinent to that individual. This article is based on research conducted at the Oregon Evidence-based Practice Center (now the Pacific Northwest Evidence-based Practice Center) with funding from the American Pain Society (APS to safety of methadone. After a review of the available evidence, the expert panel concluded that measures can be taken to promote safer use of methadone. Specific recommendations include the need to educate and counsel patients on methadone safety, use of electrocardiography to identify persons at greater risk for methadone-associated arrhythmia, use of alternative opioids in patients at high risk of complications related to corrected electrocardiographic QTc interval prolongation, careful dose initiation and titration of methadone, and diligent monitoring and follow-up. Although these guidelines are based on a systematic review, the panel identified numerous research gaps, most recommendations were based on low-quality evidence, and no recommendations were based on high-quality evidence.Perspective: This guideline, based on a systematic review of the evidence on methadone safety, provides recommendations developed by a multidisciplinary expert panel. Safe use of methadone requires clinical skills and knowledge in use of methadone to mitigate potential risks, including serious risks related to risk of overdose and cardiac arrhythmias. M ethadone is a synthetic opioid used for the treatment of opioid addiction and for treatment of chronic pain. 15,61 The safety of methadone has been called into question by data indicating a large increase in the number of methadone-associated overdose deaths.38 This increase appears largely related to the dramatic rise in the use of methadone for chronic pain, though a small proportion of deaths occur in patients treated for opioid addiction. 21,37,68,76,91,103 Methadone poisoning deaths in the United States increased steadily from about 800 in 1999 to a high of about 5,500 in 2007; th...

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“…Opioid prescription dosages were converted into morphine equivalent dosages 28 . Equianalgesic dose ratios for conversion of methadone to morphine are variable depending on the dose of methadone or morphine 29 , and therefore in this study we also reported methadone equivalents. Receipt of COT was defined as receiving prescriptions for opioids for ≥90 consecutive days.…”

Section: Methodsmentioning

confidence: 99%

Patterns of care and side effects for patients prescribed methadone for treatment of chronic pain

Macey¹,

Weimer²,

Grimaldi³

et al. 2013

J of Opioid Management

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Objectives This manuscript evaluates physician monitoring practices and incidence of cardiac side effects following initiation of methadone for treatment of chronic pain as compared to patients who began treatment for chronic pain with morphine sustained release (SR). Design We retrospectively reviewed medical record data on all new initiations of methadone and compared results of physician monitoring practices to patients with new initiations of morphine SR. A standardized chart tool was used to capture clinical data. Data related to health service utilization and clinical diagnoses were obtained from the VA clinical information system. Setting A single VA medical center in the Pacific Northwest. Patients Chronic pain patients prescribed methadone (n=92) or morphine (n=90) in the calendar year 2008. Results There was no difference between patients prescribed methadone versus patients prescribed morphine SR in the likelihood of receiving an electrocardiogram (ECG) prior to initiating medication (53% versus 54%) or in the year after opioid initiation (37% versus 40%). The two groups also did not differ in rates of developing prolonged QTc intervals (>450 ms) (11% versus 17%). Seventy-two percent of all patients discontinued their long-acting opioid regimens before 90 days due to adverse effects or insufficient pain relief. Conclusion Despite recommendations for standardized assessment and cardiac risk monitoring, few patients prescribed methadone received an ECG, and this occurred at a rate that did not differ from patients prescribed morphine SR. Patients discontinued both medications at high rates. Further research is needed to evaluate the clinical significance of QTc prolongation in patients treated with methadone.

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Morphine to Methadone Conversion: An Interpretation of Published Data

Cited by 33 publications

References 29 publications

Methods of Rotation From Another Strong Opioid to Methadone for the Management of Cancer Pain: A Systematic Review of the Available Evidence

Methods of Rotation From Another Strong Opioid to Methadone for the Management of Cancer Pain: A Systematic Review of the Available Evidence

Methadone Safety: A Clinical Practice Guideline From the American Pain Society and College on Problems of Drug Dependence, in Collaboration With the Heart Rhythm Society

Patterns of care and side effects for patients prescribed methadone for treatment of chronic pain

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