Safe and Appropriate Use of Methadone in Hospice and Palliative Care: Expert Consensus White Paper

J Pain Symptom Manage. 2019 Mar;57(3):635-645.e4. doi: 10.1016/j.jpainsymman.2018.12.001. Epub 2018 Dec 20.


Methadone has several unique characteristics that make it an attractive option for pain relief in serious illness, but the safety of methadone has been called into question after reports of a disproportionate increase in opioid-induced deaths in recent years. The American Pain Society, College on Problems of Drug Dependence, and the Heart Rhythm Society collaborated to issue guidelines on best practices to maximize methadone safety and efficacy, but guidelines for the end-of-life scenario have not yet been developed. A panel of 15 interprofessional hospice and palliative care experts from the U.S. and Canada convened in February 2015 to evaluate the American Pain Society methadone recommendations for applicability in the hospice and palliative care setting. The goal was to develop guidelines for safe and effective management of methadone therapy in hospice and palliative care. This article represents the consensus opinion of the hospice and palliative care experts for methadone use at end of life, including guidance on appropriate candidates for methadone, detail in dosing, titration, and monitoring of patients' response to methadone therapy.

Keywords: Methadone; arrhythmias; hospice; medication safety; palliative care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Analgesics, Opioid / adverse effects
  • Analgesics, Opioid / therapeutic use*
  • Hospice Care*
  • Humans
  • Methadone / adverse effects
  • Methadone / therapeutic use*
  • Pain / drug therapy*
  • Palliative Care*


  • Analgesics, Opioid
  • Methadone