The American Pain Society (APS) has published new Clinical Practice guideline on Methadone Safety in this week’s The Journal of Pain.

Methadone is a synthetic opioid narcotic approved to treat opioid addiction and chronic pain. The increase in mortality–from 800 in 1999 to 4,900 in 2008–has been significantly higher than for any other opioid medication.

Prior clinical guidelines addressed prevention of cardiac arrhythmias caused by methadone but they did not address safety non-cardiovascular safety issues. The new clinical guidelines rate recommendations as strong or weak. Strong recommendations were based on the expert panel’s assessment that potential benefits outweigh harms or burdens or that potential harms clearly outweigh the benefits.

RELATED: AAPM: Methadone Not First Drug of Choice for Chronic Pain

Some of the key recommendations include:

  • Careful patient selection for methadone is essential and should be based on a thorough history, review of medical records and physical examination.
  • Clinicians should counsel patients about potential risks and benefits prior to beginning methadone therapy.
  • ECG exams should be performed prior to initiating methadone therapy to assess risks for arrhythmias.
  • Clinicians should consider buprenorphine as an option for patients treated for opioid addiction if they have risk factors for QT prolongation.
  • Methadone treatment should be started at low doses (no more than 30–40mg daily) and titrated slowly due to its long half-life.
  • Urine drug testing should be performed before initiating therapy and at regular intervals for patients treated for opioid addiction.

For more information call (847) 375-4715 or visit