Methadone is an opioid agonist medication that has been used to treat opioid use disorder for 50 years. This medication, which is also used to treat pain, can cause adverse effects, including overdose, if not taken as prescribed. In order to prescribe methadone for treatment of OUD, healthcare providers are required to acquire and maintain certifications issued by SAMHSA.
Related Training Resources
MAT in the OTP Setting: Integrating the Three Approved Medications (Methadone, Buprenorphine, ER Naltrexone) – RevisedKelly J. Clark, MD, MBA | Chair, OTP Workgroup, American Society of Addiction Medicine
This module will give the clinician an understanding of the opportunities and challenges of integrating into the Opioid Treatment Program (OTP) environment treatment with all three FDA approved medications – methadone, buprenorphine (SL and buccal), and ER Naltrexone. The special characteristics of OTPs, and its place in the continuum of care, provide a unique environment for these pharmacotherapies. This module will discuss these, as well as clinical and operational issues involved in developing an integrated approach.
This module focuses on the role of methadone in opioid addiction treatment compared to when it is used for pain management. The module describes key pharmacological differences of methadone for the two indications, including methadone dosing and monitoring considerations. The module reviews the history of methadone and the unique regulations that apply to the use of methadone in treating opioid addiction compared to its use in treating pain. The module describes the epidemiologic impact of methadone on morbidity and mortality related to opioid use disorder compared to that related to pain. Finally, the module provides suggestions on what information patients should receive if methadone is part of a treatment regimen for opioid use disorder or pain.
This introductory module is a case-based discussion of the general approach to evaluation and treatment of patients presenting with problematic opioid use. Benefits and limitations of available medications and differences between them are described. An approach to choosing first and second line treatments is also presented.
There is clear evidence of the potential of methadone to increase the QT interval which can result in a lethal arrhythmia, Torsades de Pointes. There however has been controversy as to when and how to screen patients entering methadone treatment. This module will attempt to address this need by presenting the available literature and case studies. Clear guidelines to consider will be established.
Methadone Safety: Clinical Practice Guidelines from the American Pain Society and College on Problems of Drug DependenceRoger Chou, MD | Associate Professor of Medicine, Oregon Health & Science University, Director, the Pacific Northwest Evidence-based Practice Center
This presentation reviews evidence on methadone safety, properties of methadone, and recommendations for safer use, include careful patient assessment, use of alternative opioids and treatments, education and counseling, use of ECG screening and monitoring, careful dose initiation and titration, careful monitoring and follow-up, and use of risk mitigation strategies.
Upon completion of this module, physicians working in MMT will know how to safely induce patients to MMT, how to adjust methadone dosing for maximum effectiveness, how to detect and manage MMT side effects and medication interactions, and how to work within legal/regulatory framework of 42 CFR part 8.