Comparing Methadone Rotation to Consensus Opinion

J Pain Symptom Manage. 2020 Jan;59(1):116-120. doi: 10.1016/j.jpainsymman.2019.09.014. Epub 2019 Sep 24.


Context: Methadone is a complex but useful medication for pain management in palliative care. Recent expert opinions have been published on the safe and effective use of methadone.

Objectives: To determine the success of methadone rotations and evaluate concordance with consensus recommendations by a palliative care consult service.

Methods: A retrospective study of methadone rotation practice by a palliative care consult service and outcomes for patients hospitalized between January 1, 2012 and December 31, 2018 at a single academic medical center. A successful rotation was defined as a 30% reduction in pain or as-needed medication use sustained for at least three consecutive days. Patient outcomes were compared with expert consensus recommendations.

Results: About 59 patients met the inclusion criteria. The study population was mostly Caucasian men and women of equal proportions who were started on methadone for inadequate pain control. Sixty-eight percent of patients were successfully rotated. Subjects who were rotated using a standardized protocol were six times more likely to have a successful rotation (odds ratio 6.28 [1.25-30.92]; P = 0.0238).

Conclusion: The utilization of a standardized protocol was associated with better patient outcomes.

Keywords: Methadone rotation; guideline adherence; successful opioid rotation.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Analgesics, Opioid / therapeutic use*
  • Drug Substitution
  • Female
  • Humans
  • Male
  • Methadone / therapeutic use*
  • Middle Aged
  • Pain / drug therapy*
  • Pain Management / methods*
  • Palliative Care / methods
  • Retrospective Studies
  • Young Adult


  • Analgesics, Opioid
  • Methadone