Methadone Use in Cancer Patients with Pain: A Review

Bruera, Éduardo; Sweeney, C. Renn Upchurch

doi:10.1089/10966210252785097

Cited by 178 publications

(131 citation statements)

References 62 publications

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“…These methadone clinics are government funded operations and use different urine drug testing agencies. Second, Methadone is commonly used to treat chronic pain in the U.S. due to the following three reasons: (a) Methadone is more potent than most opioids (Bruera and Sweeney, 2002). In the setting of chronic pain, patients have built tolerance to other opioids and reqire higher doses and number of tablets.…”

Section: Discussionmentioning

confidence: 99%

Observations on the Relationship between Opioid Medications,Illicit Drugs and Heroin Use in Pain Patients

Yee¹

2011

American Journal of Pharmacology and Toxicology

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Problem statement:Patients on chronic opioid therapy are monitored to detect illicit drug use in order to deter diversion of their prescription opioids and to ensure medication adherence. The addictive potential of opioid drugs and their similar binding sites in the brain may make them potential gateway drugs for each other. Recent reports indicate that oxycodone has a high probability of leading to heroin use due to heroin's similar effects and lower cost. This study explores the correlations between heroin abuse, prescription opioids and illicit drugs using urinary excretion data from pain patients. Approach: This retrospective analysis was conducted using a database of 148,200 urine samples from pain patients during routine drug screening at Millennium Laboratories between 2008 and 2010. Samples were tested for the presence of the heroin metabolite, 6-acetylmorphine (6-AM). All samples were analyzed and were quantified using LC-MS-MS. Microsoft ® Excel 2007 and OriginPro ® 8.1 were used to calculate percentages and ratios relating heroin use to opioid medications and illicit drugs. Results: Of the 446 samples positive for 6-AM, methadone was concomitantly used most frequently (26.7%) followed by cocaine (25.6%), oxycodone (24.2%), hydrocodone (16.4%), marijuana (11.6%), buprenorphine (4.9%) and methamphetamine (4.7%). The high percentage of concomitant methadone is expected because a portion of patients were likely to be on methadone maintenance therapy for heroin withdrawal. Patients on oxycodone were twice as likely to test positive for 6-AM than those on hydrocodone(0.28% versus 0.14%). Conclusions/Recommendations: Our results indicate that patients on methadone should be most closely monitored for heroin abuse due to their high proportion of concomitant use. The proportions of concomitant use were similar between oxycodone and cocaine and were both considerably higher than marijuana, a purported gateway drug for heroin. This study suggests that oxycodone may be highly correlated with heroin use. Urine samples must be assessed in the full clinical context.

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Section: Discussionmentioning

confidence: 99%

Observations on the Relationship between Opioid Medications,Illicit Drugs and Heroin Use in Pain Patients

Yee¹

2011

American Journal of Pharmacology and Toxicology

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“…However, it has recently been 'rediscovered' as an analgesic in the treatment of chronic pain 2 and cancer pain. 3 A recent survey revealed that the prevalence of chronic pain in Canada is 29%. Of those chronic pain sufferers taking medications, 22% take opioids as an analgesic.…”

Section: Conclusion : La Méthadone Est Un Opiacé Aux Propriétés Complmentioning

confidence: 99%

“…Methadone in the form of the isolated R-Met (l-isomer) is available in Germany. 3,12 The S-Met enantiomer is inactive as a µ agonist. Nonetheless, it is a noncompetitive N-methyl-d-aspartate (NMDA) antagonist and prevents 5-hydoxytryptamine and norepinephrine reuptake.…”

Section: Conclusion : La Méthadone Est Un Opiacé Aux Propriétés Complmentioning

confidence: 99%

Review article: Perioperative pain management of patients on methadone therapy

Peng

Tumber

Gourlay

2005

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : Methadone, an opioid traditionally associated with the management of opioid addictive disorders, has been prescribed increasingly as an analgesic for the management of various chronic pain conditions. Despite the increasing popularity of methadone, most anesthesiologists are not familiar with its complex pharmacology. The purpose of this article is to review the pharmacology of methadone and to suggest a management algorithm for the perioperative care of methadone patients.S So ou ur rc ce e: : A Medline search was performed to obtain the published literature on the pharmacology of methadone and its use perioperatively.P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : The complexity of methadone's pharmacology is characterized by a high inter-individual variability, a potential for interaction with other medications, and a long elimination half-life. The postoperative management of methadone patients may be difficult as they are often 'opioid-tolerant' but may be 'pain-intolerant'. For those patients who are taking part in methadone-maintenance programs, there is a potential for the problematic use of opioids or other substances. The management plan for patients taking methadone may differ depending on the type of surgery and the associated perioperative differences in fasting status and gastrointestinal function. In consideration of all the factors listed above, a management algorithm is outlined for the perioperative care of methadone patients.C Co on nc cl lu us si io on n: : Methadone is an opioid with complex properties, and a patient that is taking methadone can represent a unique challenge to the anesthesiologist. A good understanding of the pharmacology of methadone and of the type of patients on this medication will help to improve their perioperative care. Objectif

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“…In addicts, methadone may be an important alternative to other opioids, because it has no known active metabolites and less side effects [18]. It is well absorbed by oral and rectal routes, and also has the advantage of very low cost.…”

Section: Cancer Pain and Addictionmentioning

confidence: 99%

Trust Violated: Analgesics for Addicts

et al. 2003

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Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital (MGH), founded The Kenneth B. Schwartz Center at MGH. The Schwartz Center is a nonprofit organization dedicated to supporting and advancing compassionate health care delivery that provides hope to the patient, support to caregivers, and encourages the healing process. The Center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members.Addiction among cancer patients on strong analgesics is a rare but difficult management challenge. The case is presented of a 28-year-old woman with breast cancer and painful bone metastases, suffering with dysfunctional social chaos and addicted to Percocet ® (oxycodone and acetaminophen). Having broken the trust of her health care team, trust was rebuilt by incorporating the substance abuse clinic and enforcing a contractual agreement. With open and honest support, the team was able to both care for and empower the patient. Issues of trust, liability, opioid tolerance, and barriers to optimal analgesia for cancer pain are discussed.

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Methadone Use in Cancer Patients with Pain: A Review

Cited by 178 publications

References 62 publications

Observations on the Relationship between Opioid Medications,Illicit Drugs and Heroin Use in Pain Patients

Observations on the Relationship between Opioid Medications,Illicit Drugs and Heroin Use in Pain Patients

Review article: Perioperative pain management of patients on methadone therapy

Trust Violated: Analgesics for Addicts

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