Methadone has several unique characteristics that make it an attractive option for
pain relief in serious illness, but the safety of
methadone has been called into question after reports of a disproportionate increase in
opioid-induced deaths in recent years. The American
Pain Society, College on Problems of
Drug Dependence, and the Heart Rhythm Society collaborated to issue guidelines on best practices to maximize
methadone safety and efficacy, but guidelines for the
end-of-life scenario have not yet been developed. A panel of 15 interprofessional hospice and
palliative care experts from the U.S. and Canada convened in February 2015 to evaluate the American
Pain Society
methadone recommendations for applicability in the hospice and
palliative care setting. The goal was to develop guidelines for safe and effective management of
methadone therapy in hospice and
palliative care. This article represents the consensus opinion of the hospice and
palliative care experts for
methadone use at
end of life, including guidance on appropriate candidates for
methadone, detail in dosing, titration, and monitoring of patients' response to
methadone therapy.