QT Interval Screening in Methadone Maintenance Treatment: Report of a SAMHSA Expert Panel

Martin, Judith A.; Campbell, Anthony; Killip, Thomas; Kotz, Margaret; Krantz, Mori J.; Kreek, Mary Jeanne; McCarroll, Brian A.; Mehta, Davendra; Payte, J. Thomas; Stimmel, Barry; Taylor, Trusandra; Wilford, Bonnie B.

doi:10.1080/10550887.2011.610710

Cited by 68 publications

(55 citation statements)

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“…The recommendations presented in this Guideline are based on the underlying assumption that safe use of methadone requires clinical skills and knowledge in assessing and balancing potential risks against potential benefits of methadone, monitoring and management of risks, with the core goal of promoting patient safety and preventing avoidable harms, including serious events such as accidental overdose and fatal arrhythmia. Unlike other Guidelines, 60,70,92 which primarily focused on prevention of arrhythmia, the recommendations in this Guideline also address aspects of patient risk assessment, education and counseling, dose initiation and titration, monitoring, and medication interactions that are directly or indirectly related to risk of respiratory depression, thought to be the primary cause of methadone-associated deaths.…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

“…60,70,92 Two of these guidelines were not fully endorsed by a professional society or government entity 60,92 ; the third was endorsed by the Substance Abuse and Mental Health Services Administration. 72 Although systematic literature reviews were conducted for these guidelines, a limitation is that none graded the strength of the recommendations or the quality of the evidence supporting the recommendations.…”

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confidence: 99%

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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

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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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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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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

Self Cite

206

188

View full text Add to dashboard Cite

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“…Among inpatients, relevant adverse effects may include constipation, drowsiness and QT interval prolongation. 7 Buprenorphine is a semisynthetic partial agonist with very high affinity at the opioid μ receptor. Its partial agonist property confers a ceiling effect on analgesia and respiratory depression, although 2 autopsy studies highlighted the risk of overdose when other respiratory depressants are used concomitantly.…”

Section: Opioid Agonist Therapymentioning

confidence: 99%

“…We use current guidelines, systematic reviews and current studies to familiarize readers with the use of opioid agonist therapy (Box 1), [6][7][8][9][10][11][12][13][14] management of opioid withdrawal and overdose, acute pain management and safe discharge practices for hospital inpatients with opioid use disorder (Box 2).…”

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Caring for patients with opioid use disorder in the hospital

Donroe

Holt

Tetrault

2016

CMAJ

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Effectiveness of Conditioned Open-label Placebo With Methadone in Treatment of Opioid Use Disorder

et al. 2023

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ImportanceMethadone treatment is the most effective evidence-based treatment for opioid use disorder (OUD), but challenges related to dosing and premature treatment dropout argue for adjunct interventions to improve outcomes. One potential behavioral intervention with low risk involves harnessing placebo effects.ObjectiveTo determine the effect of a pharmacologically conditioned open-label placebo (C-OLP) on 90-day methadone dose, retention, drug use, withdrawal, craving, quality of life, and sleep.Design, Setting, and ParticipantsThis 2-arm, open-label, single-blind randomized clinical trial was conducted between December 5, 2017, and August 2, 2019, in an academically affiliated community opioid treatment program. Analyses were conducted between October 1, 2019, and April 30, 2020. A total of 320 newly enrolled adults seeking treatment for moderate to severe OUD were assessed for study eligibility; 131 met eligibility criteria, provided informed consent, and were randomized to either C-OLP or treatment as usual (TAU) in an unequal-block (3:2) manner. Exclusion criteria were pregnancy, hospital/program transfers, and court-ordered treatment.InterventionsParticipants randomized to C-OLP received pharmacologic conditioning and a placebo pill and methadone, and participants randomized to TAU were given methadone only. Participants met with the study team 5 times: at baseline (treatment intake) and 2, 4, 8, and 12 weeks postbaseline. Interactions were balanced between the 2 groups.Main Outcomes and MeasuresOutcomes included 90-day methadone dose (primary) and treatment retention, drug use, withdrawal, craving, quality of life, and sleep quality (secondary). Analyses were conducted as intention-to-treat.ResultsOf the 131 people enrolled in the study, 54 were randomized to TAU and 77 to C-OLP. Mean (SD) age was 45.9 (11.2) years; most of the participants were Black or African American (83 [63.4%]) and male (84 [64.1%]). No significant group differences were observed in the mean (SD) 90-day methadone dose (83.1 [25.1] mg for group TAU, 79.4 [19.6] mg for group C-OLP; t = 0.621991; P = .43), but the groups differed significantly in their retention rates: 33 (61.1%) for TAU and 60 (77.9%) for C-OLP (χ21 = 4.356; P = .04; number needed to treat for the beneficial outcome of 3-month treatment retention, 6; 95% CI, 4-119). C-OLP participants also reported significantly better sleep quality.Conclusions and RelevanceIn this randomized clinical trial, C-OLP had no effect on the primary outcome of 90-day methadone dose. However, C-OLP participants were significantly more likely to remain in treatment. These findings support the use of C-OLP as a methadone treatment adjunct, but larger trials are needed to further examine the use of C-OLP.Trial RegistrationClinicalTrials.gov Identifier: NCT02941809

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QT Interval Screening in Methadone Maintenance Treatment: Report of a SAMHSA Expert Panel

Cited by 68 publications

References 81 publications

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

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

Caring for patients with opioid use disorder in the hospital

Effectiveness of Conditioned Open-label Placebo With Methadone in Treatment of Opioid Use Disorder

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