Evaluation of a pharmacist-managed methadone taper*

摘要

OBJECTIVES:: To evaluate the efficacy of a pharmacist-managed methadone taper as compared to previous prescribing practices. DESIGN:: Retrospective chart review with comparison to historical controls. SETTING:: Ninety-six-bed pediatric quaternary care facility with the majority of the patients in a 24-bed ICU. PATIENTS:: Thirty-two patients, 1 month to 16 years old, weaned off opioids using methadone prior to protocol initiation were compared with 20 patients, 1 month to 15 years old, weaned per the pharmacist-managed methadone taper protocol. INTERVENTIONS:: Implementation of a pharmacist-managed methadone tapering protocol. MEASUREMENTS AND MAIN RESULTS:: Patient age, gender, weight, and risk of withdrawal were similar between the groups (p = not significant). The average taper length before pharmacist intervention was 24.7 days; after implementation it was 15 days (p = 0.0026). There was no statistical difference in the number of additional doses of opioid required or withdrawal scores between the populations. Opioid infusions were stopped, on average, 1.54 days sooner in the intervention group (p = 0.0039). A decrease in hospital length of stay was also seen in the intervention group (p = 0.023). CONCLUSIONS:: A pharmacist-managed protocolized methadone taper facilitates discontinuing methadone sooner, discontinuing additional opioid infusions sooner, and may impact on the length of hospital stay. The protocol developed at the University of Minnesota Amplatz Children's Hospital has demonstrated that it is an effective method to wean pediatric patients from opioids.