"Not all pain medicines -- even within a class -- and not all patients -- are created equally," said Dr. Webster. "Methadone is a safe and effective opioid with pharmacokinetics and pharmacodynamics unlike other opioids, so knowledge about it and how it may affect a specific patient is paramount to a positive clinical outcome. Education about pain medicine is the best safeguard against the unintended deaths and side effects we've seen with methadone in the last decade."

According to Webster, simple conversion from one opioid twice a day to another twice a day is not safe. Patient pharmacogenetics (a patient's unique response to medicine based on his or her genetics), especially when converting between opioids, along with the properties of the medicine, must be taken under advisement to determine appropriate therapy. In addition, he advises that switching a patient to methadone must be done slowly and over time: start with a low dose, and titrate from there in increments that make sense for the patient and the pain condition.    

Additionally, Webster and the panel agreed that to solve the main underlying problem, which they define as a "knowledge deficit," the U.S. Food and Drug Administration, pharmaceutical manufacturers, and scientific experts should use the last decade's worth of data on methadone, as well as his review of the increase from 2001 -- 2005, to guide and determine Risk Evaluation and Mitigations Strategies (REMS) now under consideration.

Dr. Webster and his colleagues are currently involved in an upcoming targeted education program called PainSAFE to help educate physicians and patients about safe opioid prescribing. Information about this can be found online at www.nationalpainfoundation.

SOURCE American Academy of Pain Medicine