Updates from the Methadone Maintenance Program

A new commercially available methadone 10 mg/ml solution (Methadose®) has been available for purchase by pharmacies in Canada since 2012. Starting on February 1, 2014, Pharmacare will approve coverage of Methadose® for the treatment of opioid dependence. At that time, Methadose® will replace the current anhydrous methadone solution for the treatment of opioid dependence in patients registered in the BC Methadone Maintenance Program.

New prescription pads for Methadose®

Prescriptions for Methadose® for opioid dependence must only be written on a newly developed Methadone Maintenance Program prescription pad, which the College will make available to all methadone maintenance prescribers in January. At that time, prescribers will be required to return any of the former unused prescription pads to the College for secure shredding. (Physicians should keep any used carbon copy prescriptions, which form part of the patient record.)

Physicians who are exempted to prescribe methadone for opioid dependence but currently do not have a methadone prescription pad, and are using their duplicate prescription pad to write methadone prescriptions, should contact the College to ensure that they receive the new pads in 2014. These physicians may include hospital-based physicians such as hospitalists, and specialists in internal medicine, psychiatry and anesthesia.

The month of February will be considered a transition period where existing prescriptions written on the old forms will be honoured until they run out. All new prescriptions for opioid dependence must be written on the new pads.

Note: As of February 1, 2014, pharmacists will not accept new prescriptions for methadone for opioid dependence unless the prescription is written on the new pads.

The new prescription reflects medication dosage in milligrams not millilitres. The new prescription pads do not include the words “Void if Altered” since specific space has now been provided to document any special instructions. This does not mean that alterations are permitted and pharmacists will not accept altered prescriptions.

It is likely that Methadose® will also be covered by Pharmacare for the treatment of palliative and chronic non-cancer pain. Prescriptions which are for pain and not opioid dependence should be written on the duplicate prescription pad.

Although the current anhydrous methadone powder may still be available in the future, it will become less available over time and some pharmacies may not stock it.

Patient safety concerns

Methadose® is different to anhydrous methadone solution in appearance, strength and handling. The new strength of 10 mg/ml is 10 times the concentration of usual compounded methadone 1 mg/ml solution and may present a public safety risk during the transition period.

Methadose® is a red, cherry-flavoured solution and, unless diluted, does not require refrigeration. It therefore resembles many other commonly used over-the-counter medications. Patients will need to be reminded that Methadose® must be stored safely and out of reach of children. This is of particular concern given the new concentration.

Patients with a true allergy to certain ingredients of Methadose® will require approval from Pharmacare for coverage of an alternate product.

The Methadone Maintenance Program makes recommendations to Health Canada regarding physicians obtaining authorizations to prescribe methadone as exemptions under section 56 of the Controlled Drugs and Substances Act.