Management of acute pain in patients taking methadone for opioid use disorder

IV: intravenous; NSAIDs: nonsteroidal anti-inflammatory drugs; OTP: opioid treatment program.

* Methadone must be dosed more frequently for optimal analgesia than for treatment of OUD. The duration of action of its analgesic effect is 6 to 8 hours, versus >24 hours for it's anticraving effect.

¶ Expect to need higher doses of supplemental opioids for patients taking methadone than for opioid naïve patients.

Δ The patient's dose of methadone should be increased only if the patient agrees after a discussion of the rationale and the plan to return to the baseline methadone dose prior to discharge.

◊ Most patients should return to the baseline daily dose of methadone prior to discharge. For very select patients with high risk of misuse or better pain control on higher doses of methadone, it may be safer to discharge the patient on a methadone dose higher than their baseline dose rather than other opioids. This must be done in coordination with addiction medicine and the patient's OTP.