Resources For Human Development Resource Center. Error: This page requires that a Program ID be passed as a parameter. FDA prescribing information, side effects and uses. Methadone hydrochloride tablets, USP is indicated for the. Certified treatment programs shall dispense and use Methadone in oral form only and according to the treatment requirements stipulated in the Federal Opioid Treatment Standards (4. CFR 8. 1. 2). See below for important regulatory exceptions to the general requirement for certification to provide opioid agonist treatment. Failure to abide by the requirements in these regulations may result in criminal prosecution, seizure of the drug supply, revocation of the program approval, and injunction precluding operation of the program. Regulatory Exceptions To The General Requirement For Certification To Provide Opioid Agonist Treatment: During inpatient care, when the patient was admitted for any condition other than concurrent opioid addiction (pursuant to 2. CFR 1. 30. 6. 0. 7(c)), to facilitate the treatment of the primary admitting diagnosis). During an emergency period of no longer than 3 days while definitive care for the addiction is being sought in an appropriately licensed facility (pursuant to 2. CFR 1. 30. 6. 0. 7(b)). Methadone Dosage and Administration. Important General Information. Deaths have been reported during conversion to Methadone from chronic, high- dose treatment with other opioid agonists and during initiation of Methadone treatment of addiction in subjects previously abusing high doses of other agonists. With repeated dosing, Methadone is retained in the liver and then slowly released, prolonging the duration of potential toxicity. Methadone has a narrow therapeutic index, especially when combined with other drugs. Initial Dosing for Management of Pain. Methadone hydrochloride tablets, USP should be prescribed only by healthcare professionals who are knowledgeable in the use of potent opioids for the management of chronic pain. OCC features exceptional facilities and the latest in technology and offers more than 135 academic and career programs, including one of the nation’s largest and. OATS (Opiate Addiction Treatment Services) is Manitoba’s largest methadone maintenance treatment (MMT) program, and has helped hundreds of patients break the chains. Methadone information for families. Consider the following important factors that differentiate Methadone from other opioid analgesics. Population- based equianalgesic conversion ratios between Methadone and other opioids are not accurate when applied to individuals. J Psychosoc Nurs Ment Health Serv. Methadone anonymous: a 12-step program. Reducing the stigma of methadone use. Methadone Treatment Clinics - Methadone Treatment Centers - Methadone Withdrawal - Drug Abuse Treatment Clinics - Substance Abuse Treatment Centers - Opiate Addiction. Methadone Addiction Where did Methadone Come From? Methadone Hydrochloride is an opioid (a synthetic opiate) that was originally synthesised by. Methadone information for patients. Initial thoughts: Entering a methadone treatment program is a very personal decision. Hopefully, you have given this decision some. Street names: juice, meth (also used to refer to methamphetamines) What is it? Methadone belongs to the opioid family of drugs. Medication-assisted treatment (MAT), including opioid treatment programs (OTPs), combines behavioral therapy and medications to treat substance use disorders. The philosophy of the Methadone Program is based on the concept that chemical dependency is a disease that can be successfully treated. Monitor patients closely for respiratory depression, especially within the first 2. Methadone hydrochloride tablets . Deaths have occurred in opioid- tolerant patients during conversion to Methadone. While there are useful tables of opioid equivalents readily available, there is substantial inter- patient variability in the relative potency of different opioid drugs and products. As such, it is safer to underestimate a patient’s 2. Methadone requirements and provide rescue medication (e. Methadone requirements which could result in adverse reactions. With repeated dosing, the potency of Methadone increases due to systemic accumulation. Consider the following when using the information in Table 1. Doing so will result in an overestimation of the dose of the new opioid and may result in fatal overdose. Table 1: Conversion Factors to Methadone Hydrochloride Tablets. Total Daily Baseline Oral. Estimated Daily Oral Methadone Requirement. Morphine Equivalent Doseas Percent of Total Daily Morphine Equivalent Dose< 1. To calculate the estimated Methadone hydrochloride dose using Table 1. Divide the total daily Methadone dose derived from the table above to reflect the intended dosing schedule (i. Methadone dose by 3). Divide the total daily Methadone dose derived from the table above to reflect the intended dosing schedule (i. Methadone dose by 3). Example conversion from a single opioid to Methadone hydrochloride tablets: Step 1: Sum the total daily dose of the opioid (in this case, Morphine Extended Release Tablets 5. Morphine Extended Release Tablets 2 times daily = 1. Morphine Step 2: Calculate the approximate equivalent dose of Methadone hydrochloride tablets based on the total daily dose of Morphine using Table 1. Round down, if necessary, to the appropriate Methadone hydrochloride tablets strengths available. Monitor patients for signs and symptoms of opioid withdrawal or for signs of over- sedation/toxicity after converting patients to Methadone hydrochloride tablets. Conversion from Parenteral Methadone to Methadone Hydrochloride Tablets. Use a conversion ratio of 1: 2 mg for parenteral to oral Methadone (e. Methadone to 1. 0 mg oral Methadone). Titration and Maintenance of Therapy for Pain. Individually titrate Methadone hydrochloride tablets to a dose that provides adequate analgesia and minimizes adverse reactions. Continually reevaluate patients receiving Methadone hydrochloride tablets to assess the maintenance of pain control and the relative incidence of adverse reactions, as well as monitoring for the development of addiction, abuse, or misuse. Frequent communication is important among the prescriber, other members of the healthcare team, the patient, and the caregiver/family during periods of changing analgesic requirements, including initial titration. During chronic therapy, periodically reassess the continued need for the use of opioid analgesics. Because of individual variability in the pharmacokinetic profile (i. T1/2) from 8 to 5. However, because of this high variability, some patients may require substantially longer periods between dose increases (up to 1. Monitor patients closely for the development of potentially life- threatening adverse reactions (e. CNS and respiratory depression). Patients who experience breakthrough pain may require a dose increase of Methadone hydrochloride tablets, or may need rescue medication with an appropriate dose of an immediate- release medication. If the level of pain increases after dose stabilization, attempt to identify the source of increased pain before increasing the Methadone hydrochloride tablets dose. If unacceptable opioid- related adverse reactions are observed, the subsequent doses may be reduced and/or the dosing interval adjusted (i. Adjust the dose to obtain an appropriate balance between management of pain and opioid- related adverse reactions. Discontinuation of Methadone Hydrochloride Tablets, USP for Pain. When a patient no longer requires therapy with Methadone hydrochloride tablets for pain, use a gradual downward titration, of the dose every two to four days, to prevent signs and symptoms of withdrawal in the physically- dependent patient. Do not abruptly discontinue Methadone hydrochloride tablets. Induction/Initial Dosing for Detoxification and Maintenance Treatment of Opioid Addiction. For detoxification and maintenance of opioid dependence Methadone should be administered in accordance with the treatment standards cited in 4. CFR Section 8. 1. Administer the initial Methadone dose under supervision, when there are no signs of sedation or intoxication, and the patient shows symptoms of withdrawal. An initial single dose of 2. Methadone hydrochloride tablets will often be sufficient to suppress withdrawal symptoms. The initial dose should not exceed 3. To make same- day dosing adjustments, have the patient wait 2 to 4 hours for further evaluation, when peak levels have been reached. Provide an additional 5 to 1. Methadone hydrochloride tablets if withdrawal symptoms have not been suppressed or if symptoms reappear. The total daily dose of Methadone hydrochloride tablets on the first day of treatment should not ordinarily exceed 4. Adjust the dose over the first week of treatment based on control of withdrawal symptoms at the time of expected peak activity (e. When adjusting the dose, keep in mind that Methadone levels will accumulate over the first several days of dosing; deaths have occurred in early treatment due to the cumulative effects. Instruct patients that the dose will “hold” for a longer period of time as tissue stores of Methadone accumulate. Use lower initial doses for patients whose tolerance is expected to be low at treatment entry. Any patient who has not taken opioids for more than 5 days may no longer be tolerant. Do not determine initial doses based on previous treatment episodes or dollars spent per day on illicit drug use. Short- term Detoxification: For a brief course of stabilization followed by a period of medically supervised withdrawal, titrate the patient to a total daily dose of about 4. After 2 to 3 days of stabilization, gradually decrease the dose of Methadone hydrochloride tablets. Decrease the dose of Methadone hydrochloride tablets on a daily basis or at 2- day intervals, keeping the amount of Methadone hydrochloride tablets sufficient to keep withdrawal symptoms at a tolerable level. Hospitalized patients may tolerate a daily reduction of 2. Ambulatory patients may need a slower schedule. Titration and Maintenance Treatment of Opioid Dependence Detoxification. Titrate patients in maintenance treatment to a dose that prevents opioid withdrawal symptoms for 2. Methadone. Most commonly, clinical stability is achieved at doses between 8. Medically Supervised Withdrawal After a Period of Maintenance Treatment for Opioid Addiction. There is considerable variability in the appropriate rate of Methadone taper in patients choosing medically supervised withdrawal from Methadone treatment. Dose reductions should generally be less than 1. Apprise patients of the high risk of relapse to illicit drug use associated with discontinuation of Methadone maintenance treatment. Risk of Relapse in Patients on Methadone Maintenance Treatment of Opioid Addiction. Abrupt opioid discontinuation can lead to development of opioid withdrawal symptoms . Opioid withdrawal symptoms have been associated with an increased risk of relapse to illicit drug use in susceptible patients. Considerations for Management of Acute Pain During Methadone Maintenance Treatment. Patients in Methadone maintenance treatment for opioid dependence who experience physical trauma, postoperative pain or other acute pain cannot be expected to derive analgesia from their existing dose of Methadone.
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