Biomedical Sciences ETDs

Publication Date

Summer 7-1-2018

Abstract

ABSTRACT

Introduction

Inpatient initiation of methadone is ideal due to associated risks of cardiac arrhythmias and a high incidence of overdose. Evidence based guidelines have been developed for initiation of methadone for chronic noncancer pain (CNCP). The purpose of this study is to describe the frequency of pretreatment testing and high-risk prescribing in patients initiated on methadone at the University of New Mexico Hospital (UNMH).

Methods

A retrospective observational study was conducted using electronic health record data from UNMH, a southwest tertiary care center. We collected data on frequency of (1) pretreatment testing and (2) discharges with concomitant high-risk prescriptions. We then compared the frequency of these outcomes among those who received a consultation with the acute/chronic pain or palliative medicine services to those who did not.

Results

Seventy-two individuals had electrocardiogram testing performed in the 7 days prior to methadone initiation. Seventy-nine individuals had potassium testing performed 24 hours prior to methadone initiation. We noted a minority of individuals had magnesium tested within the prior 24 hours (n = 58), AST tested within the prior 24 hours (n = 35), ALT tested within the prior 24 hours (n =35), and total bilirubin tested within the prior 24 hours (n = 35). Patients were discharged on methadone with high-risk prescriptions including benzodiazepines (n = 15) and other drugs that are known to prolong the QTc interval (n = 18) in a minority of circumstances. Patients who received consultation were more likely to be older and have a longer length of stay. However, no differences in pretreatment testing or concomitant high-risk prescribing were detected between groups with consultation and those who did not, even when controlling for age and length of stay.

Conclusion

Our study describes the paucity of pretreatment electrolyte and electrocardiogram testing in our population. We also identified a number of instances of concomitant prescriptions with high risk medications. There were no differences for patients who received pain or palliative medicine consultation. Our study underscores the continued need for guidelines to assist clinicians on safe methadone prescribing for patients with CNCP.

Keywords

Methadone, Chronic pain, Non-cancer pain, inpatient, hospitalization, analgesia

Document Type

Thesis

Language

English

Degree Name

Clinical Research

Level of Degree

Masters

Department Name

Biomedical Sciences Graduate Program

First Committee Member (Chair)

Philip Kroth

Second Committee Member

Brandon Warrick

Third Committee Member

Olivia Hopkins

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