Question: Is narcotic analgesia recommended for patients currently on methadone? Would there be any synergistic effect? Would it cause the patient to relapse?
Thanks for this question. If a patient meets the indications and conditions for the Pain Medical Directive the fact that the patient is on Methadone should not result in treatment being withheld for an acute painful process. The effects in therapeutic dosing are not synergistic. With regard to relapse, there is no evidence to suggest that treatment of acute pain in a patient on Methadone with narcotic analgesics will result in relapse. Additionally, there is some evidence to suggest that not treating the patient's pain appropriately may increase their risk of relapse. The patient can always be offered the right to refuse treatment if they do not want to receive an intravenous narcotic. Alternatively, a BHP patch for consultation may be appropriate to further discuss the case.