New Guidance: In-Hospital Prescribing of Methadone for Palliative Care Analgesia

CPSM’s Prescribing Practices Program is excited to announce new guidance for the prescribing of methadone for analgesia in the context of palliative care, specifically who can prescribe this medication in hospital.

This guidance was developed in collaboration with regional palliative care leadership, drawing on the consultative support available through the Winnipeg Regional Health Authority (WRHA) Palliative Care on-call service. The College of Pharmacists of Manitoba (CPhM) was also consulted and reviewed these recommendations.

Improved Access to Timely Care

The new guidance is intended to improve patient access to timely methadone care during hospital admission, as indicated for palliative pain management.

Historically, a methadone prescribing approval was required for a physician to start or titrate methadone for palliative care analgesia in hospitalized patients. The Recommendations for In-Hospital Prescribing of Methadone for Palliative Care Analgesia provide an alternative solution to support these patients through consultation with the WRHA Palliative Care on-call team.

For Palliative Care Analgesia Only

These recommendations apply specifically and only to the inpatient prescribing of methadone for palliative care analgesia. Similar guidance has yet to be developed for prescribing methadone for analgesia. Guidance for prescribing methadone (and buprenorphine/naloxone) for opioid use disorder is available in the In-Hospital Care chapter of the Manitoba Opioid Agonist Therapy Recommended Practice Manual.

See the CPSM Practice Direction for Prescribing Methadone or Buprenorphine/naloxone for more information about methadone and buprenorphine/naloxone prescribing approvals. Please contact the Prescribing Practices Program (204-774-4344) for support with application and training.

Talia Carter & Marina Reinecke

CPSM Prescribing Practices Program