Is it safe to prescribe opioid analgesics to methadone patients?
Yes. Patients on a stable dose of methadone develop nearly complete tolerance to the analgesic, sedative, and euphorigenic effects of methadone. They receive no pain relief from their regular, daily methadone dose. Adequate pain control requires maintaining a patient’s establishing tolerance threshold with methadone at the usual dose, then providing additional analgesia. Non-narcotic analgesics should be used when pain is not severe. In the event of more severe pain, it is appropriate to use opioid agonist medication. The dose of an opioid-agonist may need to be increased because of cross-tolerance to methadone. Also, the duration of analgesia may be less than usual. It is very important to avoid using mixed agonist-antagonist medications such as pentazocine (Talwin), butorphanol tartrate (Stadol) and nalbuphine hydrocholride (Nubain). Severe opiate abstinence syndrome can be precipitated by this type of medication.