Expert Panel Releases First Guidelines for Hospice Methadone Therapy

A panel of 15 U.S. and Canadian experts has developed the first hospice- and palliative care-specific guidelines for safe and effective use of methadone.

Hospice providers increasingly turning to methadone as an effective and cost-effective method of managing patients’ pain but often lacked guidance on safe practices for prescribing and administering the drug. Methadone is often seen as a less expensive alternative to traditional therapies such as morphine or oxycodone.

“Its use is very much growing in prevalence, “ said Mary Lynn McPherson, PharmD., chair of the panel that developed the guidelines. “Of course some hospice programs are more used to using methadone, and others are less familiar, but thanks to its noted efficacy, and cost-effectiveness, it is growing in use.”


A 2018 analysis of pharmacy data found that 90 tables of methadone cost $16.21 at a well-known chain pharmacy, compared to $167.22 for 60 tablets of oxycodone, DeAnna Looper RN, senior vice president of clinical operations for Crossroads Hospice & Palliative Care said in a blog.

In another account, a Buffalo, N.Y.-based hospice in 2017 implemented strategies to reduce medication costs. According to Macy Catheter, makers of a medication administration tool, use of methadone had the greatest cost reduction impact.

However, these potential savings do come with one caveat.


“There are lot of branded long-acting and short-acting opioids that are very expensive,” McPherson said. “So yes, methadone would save money, but some would argue that you pay the piper in terms of labor because methadone requires much closer scrutiny in time, and effort.”

Pain management is a cornerstone of hospice care, in which clinicians stop curative treatments and focus on the patient’s comfort, and methadone is proving an effective method in the eyes of many hospice providers.

“Although there are scant data, most practitioners will tell you that methadone seems to frequently be very effective in pain of varying pathologies,” McPherson told Hospice News. “It’s also the only inherently long-acting opioid we have available, aside from those pharmaceutically altered, and it’s available as an oral solution.”

The guidelines will appear in the March issue of the Journal of Pain and Symptom Management, the official journal of the American Academy of Hospice and Palliative Care Medicine and the National Hospice and Palliative Care Organization.