Methadone safety: A clinical practice guideline from the american pain society and college on problems of drug dependence, in collaboration with the heart rhythm society

Roger Chou, Ricardo A. Cruciani, David A. Fiellin, Peggy Compton, John T. Farrar, Mark C. Haigney, Charles Inturrisi, John R. Knight, Shirley Otis-Green, Steven M. Marcus, Davendra Mehta, Marjorie C. Meyer, Russell Portenoy, Seddon Savage, Eric Strain, Sharon Walsh, Lonnie Zeltzer

Research output: Contribution to journalArticlepeer-review

192 Scopus citations


Methadone is used for the treatment of opioid addiction and for treatment of chronic pain. The safety of methadone has been called into question by data indicating a large increase in the number of methadone-associated overdose deaths in recent years that has occurred in parallel with a dramatic rise in the use of methadone for chronic pain. The American Pain Society and the College on Problems of Drug Dependence, in collaboration with the Heart Rhythm Society, commissioned an interdisciplinary expert panel to develop a clinical practice guideline on safer prescribing of methadone for treatment of opioid addiction and chronic pain. As part of the guideline development process, the American Pain Society commissioned a systematic review of various aspects related to safety of methadone. After a review of the available evidence, the expert panel concluded that measures can be taken to promote safer use of methadone. Specific recommendations include the need to educate and counsel patients on methadone safety, use of electrocardiography to identify persons at greater risk for methadone-associated arrhythmia, use of alternative opioids in patients at high risk of complications related to corrected electrocardiographic QTc interval prolongation, careful dose initiation and titration of methadone, and diligent monitoring and follow-up. Although these guidelines are based on a systematic review, the panel identified numerous research gaps, most recommendations were based on low-quality evidence, and no recommendations were based on high-quality evidence. Perspective This guideline, based on a systematic review of the evidence on methadone safety, provides recommendations developed by a multidisciplinary expert panel. Safe use of methadone requires clinical skills and knowledge in use of methadone to mitigate potential risks, including serious risks related to risk of overdose and cardiac arrhythmias.

Original languageEnglish (US)
Pages (from-to)321-337
Number of pages17
JournalJournal of Pain
Issue number4
StatePublished - Apr 2014


  • Clinical practice guideline
  • chronic pain
  • methadone
  • opioid addiction
  • safety

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Anesthesiology and Pain Medicine


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