Prescribing oxycodone in methadone patient

[XRT_doc]

I have a cancer patient whose in pain due to treatment. Would you prescribe oxycodone on top of their Methadone prescribed by their methadone clinic or would you have the metahdone clinic prescribe all their pain meds?

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[gutonc]

Are they on methadone for opiate addiction (maintenance) or for chronic pain. If the former, methadone clinics don't prescribe anything else so you will need to manage their pain. If it's a pain clinic and their getting methadone for that, then yes, you should absolutely defer to the pain clinic.

 

[chessknt]

Methadone clinic is typically for opiate abuse since they give out 1 pill daily which would not be appropriate for a pt in chronic cancer pain. If this pt does not have an opiate issue I would strongly consider referring to palliative or chronic pain management to allow for more logical prescription of methadone and a unified place to get opiates from in a safe way.

 

[gutonc]

I'm well aware of how a methadone clinic works. I was just asking the OP for clarification.

I have a few patients on methadone maintenance with malignant pain for whom I prescribe opiates. I make sure the methadone clinic medical director knows what I am doing (CC'ing on a note is fine) and these are some of the few patients I use a pain contract with. They piss before I put a new Rx in their hands. If they test positive for anything other than methadone, what I'm giving them or weed (I couldn't possibly care less if they smoke pot which is legal both medically and recreationally where I live), then we're done. I also check the state database each time for these folks. An Rx from someone other than an ED (<10 pills) and we're done as well.

A history of drug addiction is no reason to not treat pain. It's also not really that hard.

 

[AKMD_1984]

I'm well aware of how a methadone clinic works. I was just asking the OP for clarification.

I have a few patients on methadone maintenance with malignant pain for whom I prescribe opiates. I make sure the methadone clinic medical director knows what I am doing (CC'ing on a note is fine) and these are some of the few patients I use a pain contract with. They piss before I put a new Rx in their hands. If they test positive for anything other than methadone, what I'm giving them or weed (I couldn't possibly care less if they smoke pot which is legal both medically and recreationally where I live), then we're done. I also check the state database each time for these folks. An Rx from someone other than an ED (<10 pills) and we're done as well.

A history of drug addiction is no reason to not treat pain. It's also not really that hard.

exactly.

you highlited the typical misunderstanding among physicians that methadone is ONLY for addiction.
its not.

its a great medication for cancer pain also. its a longer acting medication, and much cheaper than other opiates.

this is where a thorough history, eval and reviewing meds become critical before treating - which i feel my referring physicians never do.

 

[Crayola227]

my philosophy, if they got some serious cancer it's as close to "party" time as I can make it, given that it's not that much of a party when they have cancer :-(

load 'em up, make 'em happy (as happy as you can be, ya know, with serious cancer)
I'm the candyman

 

[PlutoBoy]

exactly.

you highlited the typical misunderstanding among physicians that methadone is ONLY for addiction.
its not.

its a great medication for cancer pain also. its a longer acting medication, and much cheaper than other opiates.

this is where a thorough history, eval and reviewing meds become critical before treating - which i feel my referring physicians never do.

You are welcome