[CarrieH]

What's up with the insurance companies trying to get us to switch patients from Percocet, Vicodin, ect to Methadone? Even if it's cheaper, it causes more medical problems than the other treatments. Are these drug formularies even reviewed by a medical person?

Most of the patients on these pain meds are geriatric and really don't need more changes on their EKG's. I've just been sending the forms back as "not appropriate change for this patient".

Anyone else having this problem?

[txspadequeen921]

Ive been giving methadone a long time to patients with chronic pain, especially hospice patients. I have never had trouble with this pain med and they seem to tolerate it well and have good pain relief. As a matter of fact it is a preferred medication for most of our hospice companies and pain management teams. Am I missing something here?

[NRSKarenRN]

Can you explain this statement:

Even if it's cheaper, it causes more medical problems than the other treatments

That's not been my experience with this med.

[jessica]

I too would like more insight as to the statement of it causes more problems.


In my experience, Methadone has been unbelieveable in controlling both visceral and neuropathic pain. Yes, it's slow to titrate but once the correct dose is found for the patient....it ROCKS!

I'm a hospice nurse and the age of my patients range from 30's-Centurians. We have not seen that it has anymore side-effects or "problems" than other opiate analgesics. Also, it doesn't have the "euphoric" effect that some of the other opiates have.


Jessica

[Lacie]

It was a standard use when I worked in Burn ICU in conjunction with rotation of Tylox for even the most severe. We used it on all ages and I never had any issues with pts on Methadone so I'm not really sure of your concerns. From my experience it worked very well and never noted any issues cardiac wise. It's more popular than you would think actually in specific clinical areas such as Burns and Hospice.

[CarrieH]

Methadone can cause ST changes on an EKG... the cardiologist I work with has seen it happen. I'm talking about insurance companies trying to dictate what a primary care physician should prescribe to his/her patients. If you work with patients that need something as strong a methadone, that's one thing.

Using it for osteoarthritis, pain after surgery, ect in a patient that may already have cardiac issues should be up to the doctor, not the insurance company.

[clemmm78]

Insurance companies should absolutely not be dictating the use of one medication over the other unless they are identical in formation.

I have, however, given methadone to quite of few of my end-of-life patients without any untoward effects.

[txspadequeen921]

As a nurse I generally do not get into the financial/ insurance part of my patients business. If my resident needs the med and it is ordered then the patient gets it. Most of the time the time it is overridden or if the insurance still refuses the patients family pays for it. As long as I have been a nurse I just have never have had a problem with this. As far a cardiac changes... a lot of meds can cause cardiac changes and if this is the case with this med...sometimes you just have to weigh the pro's and con's of whether to give it or not.

[Altra]

http://www.internalmedicinenews.com/...45796/fulltext

Recent article from Internal Medicine News re: difficulties in dosage in prescribing methadone regimen for chronic pain control.

[Rabid Badger]

I am so glad that I never have to deal with this issue. I work in Canada.