Methadone Prescription Patterns among Pain Physicians in Colombia
Published
Jul 26, 2018
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Abstract
Background: Chronic pain is a disease with serious consequences for people, physicians, and health care systems. Chronic opioid usage is one of the therapy strategies. Methadone is among the available opioids in Colombia and it is characterized by unique pharmacological properties and increased mortality reports because of overdose and cardiovascular complications. Appropriate monitoring and prescribing patterns of methadone are associated with complications similar to chronic management with other opioids. Aim: To describe methadone prescribing patterns among Colombian pain physicians and compare them to the accepted recommendations by the international scientific community. Materials and Methods: An electronic structured survey was applied to pain specialist physicians identified through major pain study associations and national training programs. Results: Respondents of the survey are mostly experienced university certified physicians and anesthesiologists with clinical training working at university hospitals. Most of them perceive chronic opioid therapy as an effective strategy for pain relief and functional outcomes despite the lack of empirical support. Most of them know clinical practice guidelines but are not applying them despite this matter. Conclusions: We must enhance education for prescribers in order to improve patient safety. The recommended clinical practice guidelines are poorly applied by Colombian doctors. The results of this study must be cautiously assessed.
Keywords
metadona; medicamentos de prescripción; analgésicos opioides; dolor crónico.methadone; prescription drugs; opioid analgesics; chronic pain.
References
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13. Baxter LE, Campbell A, DeShields M, Levounis P, Martin JA, McNicholas L, et al. Safe methadone induction and stabilization. J Addict Med. 2013;7(6):377-86.
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15. Stallvik M, Nordstrand B, Kristensen Ø, Bathen J, Skogvoll E, Spigset O. Corrected QT interval during treatment with methadone and buprenorphine-Relation to doses and serum concentrations. Drug Alcohol Depend. 2013;129(1-2):88-93.
16. Krantz MJ, Lowery CM, Martell B a, Gourevitch MN, Arnsten JH. Effects of methadone on QTinterval dispersion. Pharmacotherapy. 2005;25(11):1523-9.
17. Weimer MB, Korthuis PT, Behonick GS, Wunsch MJ. The source of methadone in overdose deaths in Western Virginia in 2004. J Addict Med. 2011;5(3):188-202.
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19. Shaiova L, Berger A, Blinderman CD, Bruera E, Davis MP, Derby S, et al. Consensus guideline on parenteral methadone use in pain and palliative care. Palliat Support Care. 2008;6(2):165-76.
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28. Bardiau FM, Taviaux NF, Albert A, Boogaerts JG, Stadler M. An intervention study to enhance postoperative pain management. Anesth Analg. 2003;96(1):179-85, table of contents.
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30. Boynton PM, Greenhalgh T. Selecting, designing, and developing your questionnaire. Br Med J. 2004;328(7451):1312-5.
31. Schroeck H, Healy DW, Tait AR. Airway laser procedures in children and the American Society of Anesthesiologists’ Practice Advisory: A survey among pediatric anesthesiologists. Int J Pediatr Otorhinolaryngol. 2014;78(12):2140-4.
32. Nurok M, Green DST, Chisholm MF, Fins JJ, Liguori GA. Anesthesiologists’ familiarity with the ASA and ACS guidelines on Advance Directives in the perioperative setting. J Clin Anesth. Elsevier Inc.; 2014;26(3):174-6.
33. Sehgal N, Manchikanti L, Smith HS. Prescription opioid abuse in chronic pain: A review of opioid abuse predictors and strategies to curb opioid abuse. Pain Physician. 2012;15(3 Suppl):ES67-92.
34. Ivanova JI, Birnbaum HG, Schiller M, Kantor E, Johnstone BM, Swindle RW. Real-world practice patterns, health-care utilization, and costs in patients with low back pain: The long road to guideline-concordant care. Spine J. 2011;11(7):622-32.
35. Valenstein M, Bair MJ, Ganoczy D, Mccarthy JF, Ilgen MA, Blow FC. Association Between Opioid Prescribing Patterns and Opioid Overdose-Related Deaths. JAMA. 2011;305(13):1315-21.
36. American Society of Anesthesiologists Task Force on Acute Pain Management. Practice Guidelines for Acute Pain Management in the Perioperative Setting: An Updated Report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology.2012;116(2):248-73.
2. Lynch ME, Watson CP. The pharmacotherapy of chronic pain: A review. Pain Res Manag. 2006;11(1):11-38.
3. Deyo RA, Von Korff M, Duhrkoop D. Opioids for low back pain. BMJ. 2015 jan 5;350:g6380.
4. Kobus Am, Smith DH, Morasco BJ, Jonhson ES, Yang X, Petrik AF, Deyo RA. Correlates of higher dose opioid medication use for low back pain in primary care. J Pain. 2012;13(11):1131-8.
5. Moyano J, Figueras A. A review of opioid prescription in a teaching hospital in Colombia. J Pain Res. 2012;5:237-42.
6. Moyano JR, Figueras A. The medical consumption of opioids in Colombia, 1997-2007. J Pain Palliat Care Pharmacother. 2010;24(4):367-73.
7. Kahan M, Srivastava A, Wilson L, Gourlay D, Midmer D. Misuse of and dependence on opioids: study of chronic pain patients. Can Fam Physician. 2006;52(9):1081-7.
8. Kakko J, Heilig M, Sarman I. Buprenorphine and methadone treatment of opiate dependence during pregnancy: Comparison of fetal growth and neonatal outcomes in two consecutive case series. Drug Alcohol Depend. 2008;96(1-2):69-78.
9. Dunn KM, Saunders KW, Rutter CM, Banta CJ, Merrill JO, Sullivan MD, et al. Overdose and prescribed opioids: Associations among chronic non-cancer pain patients. Ann Intern Med. 2010;152(2):85-92.
10. Krebs EE, Becker WC, Zerzan J, Bair MJ, McCoy K, Hui S. Comparative mortality among Department of Veterans Affairs patients prescribed methadone or longacting morphine for chronic pain. Pain. 2011;152(8):1789-95.
11. Lynch ME. A review of the use of methadone for the treatment of chronic noncancer pain. Pain Res Manag. 2005;10(3):133-44.
12. Chou R, Cruciani R, Fiellin D, Compton P, Farrar JT, Haigney MC, 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):321-37.
13. Baxter LE, Campbell A, DeShields M, Levounis P, Martin JA, McNicholas L, et al. Safe methadone induction and stabilization. J Addict Med. 2013;7(6):377-86.
14. Chou R, Weimer MB, Dana T. Methadone overdose and cardiac arrhythmia potential: Findings from a review of the evidence for an American Pain Society and College on Problems of Drug Dependence clinical practice guideline. J Pain. 2014;15(4):338-65.
15. Stallvik M, Nordstrand B, Kristensen Ø, Bathen J, Skogvoll E, Spigset O. Corrected QT interval during treatment with methadone and buprenorphine-Relation to doses and serum concentrations. Drug Alcohol Depend. 2013;129(1-2):88-93.
16. Krantz MJ, Lowery CM, Martell B a, Gourevitch MN, Arnsten JH. Effects of methadone on QTinterval dispersion. Pharmacotherapy. 2005;25(11):1523-9.
17. Weimer MB, Korthuis PT, Behonick GS, Wunsch MJ. The source of methadone in overdose deaths in Western Virginia in 2004. J Addict Med. 2011;5(3):188-202.
18. Paulozzi LJ, Logan JE, Hall AJ, McKinstry E, Kaplan JA, Crosby AE. A comparison of drug overdose deaths involving methadone and other opioid analgesics in West Virginia. Addiction. 2009;104(9):1541-8.
19. Shaiova L, Berger A, Blinderman CD, Bruera E, Davis MP, Derby S, et al. Consensus guideline on parenteral methadone use in pain and palliative care. Palliat Support Care. 2008;6(2):165-76.
20. Warner E. Opioids for the treatment of chronic noncancer pain. Am J Med. 2012;125(12):1155-61.
21. Fine PG, Mahajan G, McPherson ML. Long-acting opioids and shortacting opioids: Appropriate use in chronic pain management. Pain Med. 2009;10(S2):S79-88.
22. van der Wees PJ, Zagers CA, de Die SE, Hendriks EJ, Nijhuisvan der Sanden NW, de Bie RA. Developing a questionnaire to identify perceived barriers for implementing the Dutch physical therapy COPD clinical practice guideline. BMC Health Serv Res. 2013;13:159.
23. Sheehan SR, Wedisinghe L, Macleod M, Murphy DJ. Implementation of guidelines on oxytocin use at caesarean section: a survey of practice in Great Britain and Ireland. Eur J Obstet Gynecol Reprod Biol. 2010;148(2):121-4.
24. Lovell M, Agar M, Luckett T, Davidson PM, Green A, Clayton J. Australian Survey of Current Practice and Guideline Use in Adult Cancer Pain Assessment and Management: Perspectives of palliative care physicians. J Palliat Med. 2013;16(11):1403-9.
25. Handler J, Lackland DT. Translation of hypertension treatment guidelines into practice: a review of implementation. J Am Soc Hypertens. 2011;5(4):197-207.
26. Beehler GP, Funderburk JS, Possemato K, Vair CL. Developing a measure of provider adherence to improve the implementation of behavioral health services in primary care: a Delphi study. Implement Sci. 2013;8(1):19.
27. Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344-9.
28. Bardiau FM, Taviaux NF, Albert A, Boogaerts JG, Stadler M. An intervention study to enhance postoperative pain management. Anesth Analg. 2003;96(1):179-85, table of contents.
29. Edwards PJ, Roberts I, Clarke MJ, DiGuiseppi C, Wentz R, Kwan I, et al. Methods to increase response to postal and electronic questionnaires. Cochrane Database Syst Rev. 2009; (3):2009-11.
30. Boynton PM, Greenhalgh T. Selecting, designing, and developing your questionnaire. Br Med J. 2004;328(7451):1312-5.
31. Schroeck H, Healy DW, Tait AR. Airway laser procedures in children and the American Society of Anesthesiologists’ Practice Advisory: A survey among pediatric anesthesiologists. Int J Pediatr Otorhinolaryngol. 2014;78(12):2140-4.
32. Nurok M, Green DST, Chisholm MF, Fins JJ, Liguori GA. Anesthesiologists’ familiarity with the ASA and ACS guidelines on Advance Directives in the perioperative setting. J Clin Anesth. Elsevier Inc.; 2014;26(3):174-6.
33. Sehgal N, Manchikanti L, Smith HS. Prescription opioid abuse in chronic pain: A review of opioid abuse predictors and strategies to curb opioid abuse. Pain Physician. 2012;15(3 Suppl):ES67-92.
34. Ivanova JI, Birnbaum HG, Schiller M, Kantor E, Johnstone BM, Swindle RW. Real-world practice patterns, health-care utilization, and costs in patients with low back pain: The long road to guideline-concordant care. Spine J. 2011;11(7):622-32.
35. Valenstein M, Bair MJ, Ganoczy D, Mccarthy JF, Ilgen MA, Blow FC. Association Between Opioid Prescribing Patterns and Opioid Overdose-Related Deaths. JAMA. 2011;305(13):1315-21.
36. American Society of Anesthesiologists Task Force on Acute Pain Management. Practice Guidelines for Acute Pain Management in the Perioperative Setting: An Updated Report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology.2012;116(2):248-73.
How to Cite
Moreno Martínez, D. A., ilva Enríquez, P. N., & Moyano Acevedo, J. R. (2018). Methadone Prescription Patterns among Pain Physicians in Colombia. Universitas Medica, 59(3), 1–10. https://doi.org/10.11144/Javeriana.umed59-3.ppmm
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