Patients taking methadone for opioid substitution

Methadone is used in opioid substitution programs to reduce craving and suppress withdrawal symptoms. Acute pain in patients taking methadone for opioid substitution should be managed similarly to opioid-tolerant patients, see here for management advice.

If a patient on methadone presents with acute pain, contact the patient’s methadone provider or dispensing pharmacist to verify the dose and discuss management plans. Patients on opioid substitution programs may be concerned about relapse if additional opioids are administered. Effective communication and planning are essential. Consider early consultation with an acute pain service for patients in hospital.

If additional opioids are required to manage moderate or severe acute pain, continue the patient’s usual methadone dose and add an immediate-release opioid commonly used for acute pain on an ‘as-required’ basis—patient-controlled analgesia (PCA) may be useful. If unable to take methadone orally, parenteral administration may be possible; seek specialist advice. Liaise with the patient’s methadone provider regarding resumption of dosing on discharge.