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Published on: April 23, 2019
Comparing Methadone Rotation to Consensus Opinion
Michael A Smith1, Kyle C Quirk1, D'Anna C Saul2
1Department of Pharmacy Services, Michigan Medicine, Ann Arbor, Michigan, USA; University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA.
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.
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