Methadone as pain tx

  1. 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?
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  2. 11 Comments

  3. by   txspadequeenRN
    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?
  4. by   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.
  5. by   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
  6. by   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.
  7. by   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.
  8. by   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.
  9. by   txspadequeenRN
    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. :spin:
  10. by   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.
  11. by   Rabid Badger
    I am so glad that I never have to deal with this issue. I work in Canada.
  12. by   thejimster
    "our government calls methadone the "gold standard" in treatment.

    there are between 800,000 & 900,000 (some stats give diff numbers) heroin addicts in the u.s and 1,881 people died from heroin in the u.s. in 2004.

    there are 200,000 people on methadone for drug treatment and i don't have the number of people on it for pain but even if we double the 200,000 and assume it's 400,000 total people on methadone there were 3,849 deaths in 2004

    it looks like the "gold standard" if killing more then the drug its supposed to save people from!!!!

    every day 10.9 people die from methadone (according to 2004 stats)

    we are the families of victims and those yet to be victims of methadone. [color=#003399]www.harmd.org i have come together with many other families throughout the united states who have lost loved ones to methadone."

    lol canada guy's funny, eh
    i took this statement off a website and am somewhat confused about methadone. i saw that a few people did not understand what carrieh was speaking about so i decided to post some information here

    i got the info from here:
    http://forums.families.com/pros-and-...hadone,t107632

    many people said that they personally did not have problems with methadone as a treatment, and i will be doing some more research on the subject.
  13. by   RN.38SPCL
    i can't imagine why doctors are prescribing methadone for anyone unless they are dying. i worked hospice for 5 years and we used morphine and methadone. methadone is addictive but if you're dying it doesn't matter. i work in a jail and there are so many young healthy people that get arrested for illegal possession of narcotics, falsifying / forgeing prescriptions etc. yet they all have 1 or 2 doctors who are willing to prescribe this crap knowing full well they are abusing it and or selling it. the doctors are enableing drug addicts who don't even have a diagnosis to support the medicine. if someone is a drug addict they should be treated for the mental disorder that causes them to seek these drugs. not give them a license to continue. why are doctors so afraid of their patients? i have sent for records looking for a diagnosis to support the med for a patient and found note after note where the doctor writes, " this pleasant gentelman tested negative for substances including the one's i wrote for him and is back for a refill of his methadone. this gentelman states he wrecked his car yesterday and took more methadone than usual and that is why he is out so soon." "i suspect he is not following our contract but will go ahead and give him another 30 day supply in light of the fact that he did reinjur himself and will drug test him again prior to any more refills. i have explained this to him and he understands." every month the same note from the doctor. for over a year the doctor says "ok, but this is the last time i'm writting for you".
    Last edit by UM Review RN on Apr 30, '08 : Reason: TOS

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