New methadone is 10 times more concentrated than the currently compounded anhydrous methadone solution. Are we ready to prevent potential overdoses?
Between 1 February and 1 March 2014 Pharmacare will transition patients on methadone for opiate substitution therapy and analgesia from the currently compounded anhydrous methadone solution (1 mg/mL) to Methadose, a 10 mg/mL solution.[1,2] Methadose has been available for purchase by pharmacies in Canada since 2012 and since 1973 in the US. Although the benefits of Methadose are understood—consistent dosing, longer shelf life, painful if injected, ability to be stored unrefrigerated (if not diluted)—the transition to this stronger medication presents a potential public safety risk.
In BC there are 14572 patients registered on methadone maintenance therapy (MMT) and some patients, under physician discretion, are permitted to take home daily doses (carries) up to a maximum of 35 days. Currently, methadone 1 mg/mL is dispensed diluted in an orange-flavored drink up to about 100 mL. Methadose is a red, cherry-flavored solution and, when undiluted, resembles many other commonly used over-the-counter medications. In BC new prescriptions are required starting 1 February 2014.
Methadose will be dispensed undiluted in small, individually dosed, child-resistant containers, which, if not locked up, could lead to increases in unintentional pediatric overdoses because 1 mL Methadose is a lethal dose in children. The risk of unintentional adult overdoses during the transition is also of concern. There is a known risk of overdose from methadone during initiation, titration, and tapering of doses, and now titration will be more difficult with the concentrated formulation. Patients on MMT should be adequately informed to prepare for the change, as the transition may increase psychosocial stress. Furthermore, in the event that doses are diverted, public awareness is important. By being aware of the upcoming changes and educating patients about the potential hazards, it is our goal to prevent methadone overdoses—especially through this transition period.
For more information visit http://towardtheheart.com, or contact the BC Drug and Poison Information Centre at 1 800 567-8911.
—Olivia Sampson, MD, MPH
—Jane Buxton, MBBS, MRCGP, MHSc, FRCPC
—Ashraf Amlani, MPH
1. College of Physicians and Surgeons of British Columbia. BC methadone program. Accessed 7 January 2014. www.cpsbc.ca/programs/bc-methadone-program/methadose.
2. College of Pharmacists of British Columbia. Key initiatives. Accessed 30 December 2013. www.bcpharmacists.org/about_us/key_initiatives/index/articles144.php.
3. College of Physicians and Surgeons of British Columbia. Annual Report 2012/2013. Accessed 19 December 2013. https://www.cpsbc.ca/about-us/board-committees/annual-report.
4. Shadnia S, Rahimi M, Hassanian-Moghaddam H, et al. Methadone toxicity: Comparing tablet and syrup formulations during a decade in an academic poison center of Iran. Clin Toxicol (Phila) 2013;51:777-782.
5. Latowsky, M. Methadone death, dosage and torsade de pointes: Risk-benefit policy implications. J Psychoactive Drugs 2006;38:513-519.
Above is the information needed to cite this article in your paper or presentation. The International Committee
of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally
accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.
BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:
- Only the first three authors are listed, followed by "et al."
- There is no period after the journal name.
- Page numbers are not abbreviated.
For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org