Potential Safety Risks for Methadone Maintenance Identified

Researchers at Boston Medical Center have identified potential safety risks for patients being treated for long periods of time with methadone. Methadone maintenance treatment (MMT) is a chronic therapy for opioid dependence, and is typically provided separately from medical care.

Ideally, when patients in MMT engage in outpatient or inpatient medical care, physicians are aware of the MMT and document both opioid dependence and methadone on the medical history. However, when this is not done, there is a risk of interaction between methadone and other medications, which could potentially cause adverse side effects such as overdose, cardiac arrhythmia, and decreased cognitive function.

Boston Medical Center (BMC) researchers wanted to identify potential safety risks among MMT patients receiving medical care by evaluating the frequency that opioid dependence and MMT documentation were missing in medical records and characterizing potential drug interactions with methadone.

The researchers found that documentation of opioid dependence was missing from the medical record in 30 percent of subjects. Documentation of MMT was missing from either the last discharge summary or last primary care note in 11 percent of subjects; among subjects seen by a primary care doctor, documentation of MMT was missing in 7 percent of subjects; and among subjects discharged from the inpatient hospital, documentation of MMT was missing in 10 percent of subjects.

In addition, 69 percent of the subjects were taking at least one medication that potentially interacted with methadone and 19 percent were taking three or more potentially interacting medications.

“Among patients receiving MMT and medical care at different sites, documentation of opioid dependence and MMT in the medical record occurs for the majority, but is missing in a substantial number of patients," said lead author Alexander Walley, MD, MSc, general internist in the Clinical Addiction Research and Education Unit at BMC and assistant professor of medicine at Boston University School of Medicine.

"Most of these patients are taking prescribed medications that potentially interact with methadone. This study demonstrates opportunities to improve communication, care coordination, and patient safety among patients receiving medical and substance use treatment."

Posted on July 13th, 2009

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