A DOCS Education member writes:
I have a new patient coming in who is on methadone daily for his opiate habit. I know he will be difficult to sedate, but what other concerns should I have and what questions should I ask his physician?
Dr. Anthony Feck, Dean of DOCS Education Faculty responds:
The concerns are the patient's compliance, the challenges in sedating the patient, and the potential to adversely affect the patient's addiction recovery. I would confirm the patient is compliant in his addiction recovery program.
As you correctly surmised, this patient will be a challenge to sedate due to cross-tolerance to other CNS depressants. Still, you should sedate over top of the methadone, dosing slowly to effect. The potential need for another form of sedation should be mentioned to the patient and documented. You should have a conversation with the patient beforehand regarding the potential for relapse. The chance exists whenever medication with a euphoric effect is administered.
