Methadone question

[southern_rn_brat]

I work in a nursing home and our medical director frequently prescribes Methadone for chronic pain in daily doses of 2.5mg. It is very effective for these patients and often they need very little medications for break thru pain.

My question is this....

I am the nursing supervisor and the nurses have questioned me alot about methadone treatment. Many of them state that they way they understand how methadone works in the body is that even if the patient takes another pain med (oxycodone etc) that the methadone makes it ineffective in the body.

This is the way that I explained methadone treatment to them. I need to know if I told them right, lol.

I told them that Methadone is a very effective pain medication. That yes, it is used as a treatment for heroin but it is used at much higher doses for that. When used in smaller doses it is an effective pain medication. I explained to them that it is an opioid and does not make other narcotics "ineffective" in the body (it doesnt "cancel" them out as one nurse asked).

They were concerned when she started ordering methadone. Most of them had only heard of methadone as a treatment for heroin.

Did I explain it correctly? The way I understand how methadone works is that it is just another opioid that is very effective in pain relief.

I have read how it works in the body and this is how I understand it and how I understood it when the doc explained it to me. I just dont want to be telling my nurses the wrong information.

My ex husband had acute intermittent porphyria. His doctor prescribed methadone for pain when the demerol stopped working (we all thought he couldnt take morphine at the time). The way the nursing staff treated him when they saw he was taking methadone broke my heart. Of course, this was in the early 90's and things are different now, thank God. His doc explained methadone to me this same way then but I want to make sure I am understanding it.

Any thoughts?

[doodlemom]

Methadone is unique in that it hits more receptor sites than any other narcotic - therefore providing better pain control. Other narcotics are useful in providing short acting pain relief for breakthrough pain. Methadone is better as a routine q 8 hr dose and has a very long half life so should only be titrated after many days on the same dose. Many times we have started elderly thin and fragile patients on a low dose at bed time (2.5 mg is usally what we use) and work up from there. With some patients the 2.5 mg at night is all they need. Methadone doesn't make any other narcotics ineffective - they are great for breakthrough pain and if a patient is requiring a lot of prn meds then the methadone dose should be increased. I think that the stigma around methadone is not as it was years ago because it is being used widely in pain clinics and oncology clinics - though most of the the general public probably still thinks of it as only used in drug treatment.

[AlexCCRN]

Nursing ignorance and prejudice when it comes to pain meds is discouraging. Once daily dosing - methadone has a long half-life - and analgesia efficacy makes methadone an excellent choice for RTC pain management. Other short-lived narcotics can be used for breakthrough. Any alterations in renal excretion must be considered before dosing.

[suebird3]

i know i posted in another thread about this, but we can't use methadone at our facility. why? 1st...abuse potential. 2nd....there are more "effective" medications. this is per our pharmacy. we would have to get the med probably froma methadone clinic. the hospice we use just had an inservice on this, and i am awaiting on what they have to say. pharmacy was shorthanded, so didn't have a chance to ask about hospice patients.

[doodlemom]

i know i posted in another thread about this, but we can't use methadone at our facility. why? 1st...abuse potential. 2nd....there are more "effective" medications. this is per our pharmacy. we would have to get the med probably froma methadone clinic. the hospice we use just had an inservice on this, and i am awaiting on what they have to say. pharmacy was shorthanded, so didn't have a chance to ask about hospice patients.

abuse potential? the reason why methadone is used for heroin withdrawal is because it doesn't give the same buzz. i would think that any other narcotic would have a much greater abuse potential. i hope that your pharmacy will become better educated on this. is your pharmacy in house? are you only able to use meds from your pharmacy? any pharmacist should know the pharmacokinetics of methadone - or can easily look it up. methadone is not a patent drug and therefore is not marketed to prescribers. that has prevented it from being widely used as an analgesic and unfortunately has prevented education of it's use. methadone acts at more receptor sites than any other narcotic, including delta, mu, kappa, and nmda. the nmda receptors are important in neuropathic pain. methadone is also the only narcotic that is an agonist on the delta receptors - which causes analgesia only - no euphoria. we deal with a great deal of mega-pharmacies that only deal with facilities and i have never run across a problem with it. in dealing with small pharmacies, i've never been questioned about prescriptions for methadone. if they don't have it in, they will just order it for a patient and it will come in the next day. if they don't have a certain strength, they are always able to order and it will come in the next day. no questions asked. it is unfortunate that your pharmacy will not fill scripts for methadone. maybe the hospice that is doing the inservice has a pharmacy that will deliver to your nursing facility?? maybe your input can be the catalyst in making change at your facility (or maybe not, if it will cause a problem.) good luck.

[LoriAlabamaRN]

Years ago, after breaking my back in a car accident I was given Methadone for breakthrough pain (while still in the hospital). I turned it down for two days until my doctor sat with me and explained basically what has been explained above... that it is not used just for heroin addicts, and that it does not make me a "junkie." I tried it, and not only did it leave my head clear but I didn't have to take the demerol shots anymore... the pain was helped that much! I didn't have to take it long (in fact, I was given a prescription for it upon discharge but never filled it) but it really was effective while I needed it. It's a shame there is such a stigma associated with its use.

Lori

[suebird3]

doodle.....thanx for your reply. of course, my ltc facility has one of those "conglomorate" pharmacies. lots of public aide people.....i had asked about methadone used for hospice patients, but.......that subject had to be cut short. i am sure they (the pharmacy) would do something for hospice people; then again.....the hospice nurse said they had just had an inservice themselves on the subject. guess it takes awhile to get the messege across. then, all the other hoops to jump through.... will let ya know what else i find out!!