Methadone Management
and Administration
New Corporate Policy
March 20, 2013
Methadone Management and Administration
Why a Methadone Management and Administration
Policy?
 LHSC did not previously have a corporate wide
methadone policy and as a result of a critical event
involving methadone a methadone policy has been
developed.
 The goal of this policy is to assist all members of the
health care team to safely manage the ordering,
dispensing and administration of methadone
1
1
Methadone Management and Administration
Ordering Methadone



2
MRP or Consulting Physicians may order methadone. This order
can be given to a Resident or Clinical Fellow via telephone or
verbal order but it must be signed within 24 hours.
MRP or Consulting Physicians MUST have or obtain an
exemption (i.e. authorization) to prescribe methadone.
The exemptions are obtained specifically by indications:
 methadone maintenance treatment (MMT) – addiction
 pain syndromes (Pain I, Pain II, Pain III) – chronic pain
2
Methadone Management and Administration
Ordering Methadone – Temporary Exemption
 For Medical Staff that do not hold a prescribing
exemption, a Temporary Exemption must be obtained
as soon as possible after the patient is admitted.
•
•
•
The exemption is for a specific patient only and expires upon discharge
or after 60 days. If a patient is admitted for longer than 60 days, a new
exemption is required.
Any time a methadone order is issued, the prescribing physician MUST
have an exemption (i.e. if the Medical Staff changes on a clinical team
AND the patient requires a change in does – so a new order is written –
a Methadone exemption is required for the new prescriber.
Responsibility to obtain a temporary exemption lies with the MRP,
however Pharmacy is able to assist in obtaining this in a timely manner.
Patients cannot receive methadone at LHSC unless
it is prescribed by Medical Staff with an exemption
3
3
Methadone Management and Administration
While in hospital
 Most patients continue on the same dose of
methadone during hospitalization
 Dose adjustments may be required because of:
•
•
•
•

4
Drowsiness or intoxication (e.g., because of other drugs)
QTc prolongation
MMT patients that have missed 3 or more doses
Drug interactions
Often it is most appropriate to consider dose
adjustments in consultation with a patient’s
community methadone prescriber
4
Methadone Management and Administration
Dispensing
 Previously patients brought their own methadone into
the hospital. It was secured and used throughout their
stay
 This will NO longer be the practice at LHSC. All
inpatients receiving methadone treatment will have
their methadone dispensed from the inpatient
pharmacy.

5
Any methadone that is brought into hospital will be
sent home or secured until discharge as per the
policy.
5
Methadone Management and Administration
Verifying the Dose
 Before methadone can be dispensed at LHSC, the
patient’s community pharmacy must be contacted and
all relevant information about the patient’s
methadone must be verified and documented in the
chart
 On most units, Pharmacy staff will complete this
documentation.
6
6
Methadone Management and Administration
Dispensing
 Methadone in the community is dispensed as tablets
or bulk liquid for chronic pain management, or as a
single-dose (daily) format for MMT patients
 LHSC will dispense all methadone in appropriately
labeled unit dose format on a daily basis.

This will be delivered to the units and signed into the
narcotic disposition record and administered as per
the Narcotic and Controlled Substances Policy.
•
•
7
Methadone for PAIN will be dispensed as tablets or undiluted liquid
Methadone for MMT will be dispensed as a liquid diluted in an orange
liquid (usually in 100 mL)
7
Methadone Management and Administration
Leave of Absence
 The patient’s usual methadone dispensing pharmacy
MUST be notified by LHSC pharmacy staff that the
patient is on LOA to ensure patient doesn’t double
dose.


Pain I & Pain II (For Chronic Pain and Palliative Care Patients):
 Methadone will be prescribed according to the Narcotic policy and
at the discretion of the physician with exemption status.
 Dispense according to LHSC Pharmacy procedure for LOAs.
For Methadone Maintenance Therapy (MMT) & Pain III:

Patients who are granted a Leave of Absence form LHSC should return to
the inpatient unit to receive their daily doses of methadone.
Follow specific procedure as per Methadone Management
and Administration
8
8
Methadone Management and Administration
Discharge
 Discharge planning is very important for MMT
patients.
•
•
•

Weekend discharges should be avoided whenever possible
Community physicians and pharmacies providing outpatient care for
methadone patients to be discharged MUST be contacted well in
advance of discharge to ensure that transfer of care of methadone
prescribing and dispensing is not interrupted.
Patients should receive their methadone dose at LHSC on the day of
discharge.
A temporary exemption does not allow prescribing of
methadone on discharge.
•
Discharge prescriptions should be marked “not required” for methadone
Follow specific procedure for discharge as per Methadone
Management and Administration
9
9
Methadone Management and Administration
Questions?
 Contacts
 Nursing Professional Practice
OR
 Pharmacy
10
10