We hear from Rusan Pharma Ltd. that they have made Methadone available for sale in India. Naturally, any of us will need to go through the licensing process as stipulated by the NDPS Act, till the new Amendment is implemented. This process of implementation, we expect, will take a few more months.
It is timely that Mr David Joranson brought to our attention the recent paper on methadone safety. This paper gives a clinical practice guideline from the American Pain Society and College on Problems of Drug Dependence, in Collaboration With the Heart Rhythm Society. The article is available for download here.
The big advantage is that, for the first time, we would have a low cost alternative to morphine, so that patients who do not tolerate morphine because of neurotoxicity now have an alternative. On the downside, methadone does not have the safety profile that morphine can boast of. Hence, greater caution is required in its use. The palliative care fraternity of the country have the responsibility to educate its fellow members in the proper use of methadone.
Specific recommendations from the American Pain Society include the need to educate and counsel patients on methadone safety, use of electrocardiography to identify persons at greater risk for methadone-associated arrhythmia, use of alternative opioids in patients at high risk of complications related to corrected electrocardiographic QTc interval prolongation, careful dose initiation and titration of methadone, and diligent monitoring and follow-up.