In an effort to enhance patient safety in Opioid Treatment Programs
(OTPs), the Substance Abuse and Mental Health Services Administration (SAMHSA)
convened a multi-disciplinary Expert Panel on the Cardiac Effects of Methadone.
Panel members reviewed the literature, regulatory actions, professional
guidances, and OTPs’ experiences regarding adverse cardiac events
associated with methadone.
The Panel concluded that, to the extent possible, every OTP should have a
universal Cardiac Risk Management Plan (incorporating clinical assessment, ECG
assessment, risk stratification, and prevention of drug interactions) for all
patients, and should strongly consider patient-specific risk minimization
strategies (such as careful patient monitoring, obtaining ECGs as indicated by a
particular patient’s risk profile, and adjusting the methadone dose as
needed) for patients with identified risk factors for adverse cardiac events.
The Panel also suggested specific modifications to informed consent documents,
patient education, staff education, and methadone protocols.
Careful management of methadone induction and stabilization, coupled with patient education and increased clinical vigilance, can save lives in this vulnerable patient population.
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