Open Access Open Access  Restricted Access Subscription or Fee Access

Tapering off long-term methadone: A case study

Kehua Zhou, MD, DPT, LAc, Leslie Frankish, BS, Gary G. Wang, MD, PhD

Abstract


Opioid tapering may be necessary for patients on long-term opioids. Here, the authors presented a patient who had uncontrolled chronic musculoskeletal pain while on chronic methadone. Upon methadone tapering, the patient had been taking methadone for longer than six years and had severe methadone-related adverse effects. Using multidisciplinary interventions of patient education and counseling, physical interventions, and nonopioid medications, patient’s methadone was discontinued after longer than one year tapering with relatively good pain control. The tapering process highlights the importance of pain management during opioid tapering using multidisciplinary interventions to prevent and treat opioid withdrawal and pain relapses.


Keywords


methadone tapering, opioid addiction, chronic pain, tapering

Full Text:

PDF

References


American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 2013. 5th ed., Arlington, VA: American Psychiatric Association.

Berna C, Kulich RJ: Tapering long-term opioid therapy in chronic noncancer pain: Evidence and recommendations for everyday practice. Mayo Clin Proc. 2015; 90(6): 828-842.

Dowell D, Haegerich TM, Chou R: CDC guideline for prescribing opioids for chronic pain—United States. JAMA. 2016; 315(15): 1624-1645.

Riksheim M, Gossop M, Clausen T: From methadone to buprenorphine: Changes during a 10 year period within a national opioid maintenance treatment programme. J Subst Abuse Treat. 2014; 46(3): 291-294.

Mattick RP, Breen C, Kimber J, et al.: Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database Syst Rev. 2009; (3): CD002209.

Argoff CE, Silvershein DI: A comparison of long- and short-acting opioids for the treatment of chronic noncancer pain: Tailoring therapy to meet patient needs. Mayo Clin Proc. 2009; 84: 602-612.

Chou R, Cruciani RA, Fiellin DA, et al. 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. J Pain. 2014; 15(4): 321-337.

Krebs EE, Becker WC, Zerzan J, et al.: Comparative mortality among Department of Veterans Affairs patients prescribed methadone or long-acting morphine for chronic pain. Pain. 2011; 152(8): 1789-1795.

Zhou K, Jia P, Bhargava S, et al. Opioid tapering in patients with prescription opioid use disorder: A retrospective study. Scand J Pain. 2017; 17: 167-173.

Schuckit MA. Treatment of opioid-use disorders. N Engl J Med. 2016; 375(4): 357-368.

Darnall BD, Ziadni MS, Stieg RL, et al.: Patient-centered prescription opioid tapering in community outpatients with chronic pain. JAMA Intern Med. 2018; 178(5): 707-708.

Roditi D, Robinson ME. The role of psychological interventions in the management of patients with chronic pain. Psychol Res Behav Manag. 2011; 4: 41-49.

Bautista LE, Vera-Cala LM, Colombo C, et al.: Symptoms of depression and anxiety and adherence to antihypertensive medication. Am J Hypertens. 2012; 25(4): 505-511.

DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: Meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med. 2000; 160(14): 2101-2107.

Hyman SM, Fox H, Hong K-IA, et al.: Stress and drug-cue-induced craving in opioid-dependent individuals in naltrexone treatment. Exp Clin Psychopharmacol. 2007; 15(2): 134-143.

Grüsser SM, Thalemann CN, Platz W, et al.: A new approach to preventing relapse in opiate addicts: A psychometric evaluation. Biol Psychol. 2006; 71(3): 231-235.

Gureje O, Von Korff M, Simon GE, et al.: Persistent pain and well-being: A World Health Organization Study in Primary Care. JAMA. 1998; 280(2): 147-152.

Ligthart L, Gerrits MMJG, Boomsma DI, et al.: Anxiety and depression are associated with migraine and pain in general: An investigation of the interrelationships. J Pain. 2013; 14(4): 363-370.




DOI: https://doi.org/10.5055/jom.2019.0520

Refbacks

  • There are currently no refbacks.