The American Academy of Pain Medicine (AAPM) has issued a position paper warning state and private insurers that methadone should not be considered a drug of first choice for chronic pain. While methadone represents approximately 2% of all opioid prescriptions, it is associated with one-third of all opioid-related deaths.
Currently, 33 states designate a varying methadone formulation as a preferred analgesic in their state preferred drug lists (PDLs). PDLs are a means for publically-funded health plans to be cost-effective and deliver clinically-appropriate prescription medications; the inclusion of methadone on the PDLs means that it is less expensive and easier to obtain than other pain medications. Drugs that do not appear on the state PDL may require prior state agency authorization or a certification by the prescribing physician.
The AAPM adds that methadone should only be prescribed by healthcare professionals with experience in methadone use in patients or those who have received special training. This opinion also concurs with the CDC’s stated position. Recommended methadone education program components should include primary problems identified in methadone prescribing and proficiency on points such as methadone’s unique pharmacology, patient monitoring for dose adherence and tapering/discontinuation, and potential cardiac toxicities and possible drug interactions.
For more information visit the AAPM website.