What should a clinician know about methadone before prescribing it for pain?
Pain experts typically administer opioids in the belief that patients quickly develop near complete tolerance to respiratory depression. Research is beginning to indicate that clinicians may underestimate the risk of respiratory depression, particularly in the initial conversion to methadone. Methadone is eliminated from the body at a slower rate than many other opioids. Its long, variable half-life averages around 48 hours but can be up to 100 hours. Methadone’s properties increase its potential for polydrug interactions. Also, if patients defy medical direction and escalate methadone doses in an attempt to control their pain, the results can be lethal. Q. What is methadone’s relationship to sleep? Methadone-related deaths may be influenced by a patient’s dosing schedule, including time of the last dose of the day in relation to the onset of sleep. In particular, the presence of sleep apnea appears to pose a risk: New research suggests a relationship between doses of methadone and inc
