Consideration in the Management of Acute Pain for Clients on Methadone

Addiction treatment issues:

• Reassure the client that their addiction history will not prevent adequate pain management. Asking all clients as part of a standard history/intake facilitates a non-judgmental approach.
• Prior to treating the pain, the dispensing methadone provider should be notified, and confirmation of last dose of methadone should be made.
• The methadone prescriber should be notified of admission to hospital and notified of discharge so that methadone can be continued at the present dosage. This is especially prudent if a discharge is on a weekend when the methadone prescriber may be difficult to reach to providea script to pick up methadone in the community. Ideally, the client should have an appointment made with their methadone prescriber for shortly after discharge.
• Notify the methadone provider of any prescriptions the client may have been given in hospital, such as benzodiazepines or opioids, and if they are being continued, as these will show up in routine urine toxicology screens.
• If the client is given a prescription for opioids on discharge, the methadone provider should be notified and the medications dispensed in the same manner as the methadone prescription, e.g. if the client attends the pharmacy daily for methadone, pain medications should be dispensed daily.

Tips for Pain Management Issues in Hospital:

• Relieve client anxiety by discussing the plan for pain management in a non-judgmental manner.
• Use conventional analgesics, including opioids, to aggressively treat the pain.
• Opioid cross-tolerance and client’s increased pain sensitivity will often necessitate adding extra opioid analgesic doses administered at shorter intervals.
• Continuous scheduled dosing orders rather that as-needed orders are more appropriate.
• Avoid mixed agonist and antagonist opioids, as they may precipitate an acute withdrawal syndrome.
• Increase surveillance for respiratory distress for clients on methadone with added opioids.