The poor use of methadone in Italian hospices

Abstract

Purpose: A hospice may provide an ideal setting to use methadone because of a more protective environment in comparison with a home care setting, where it is seldom used. The aim of this survey was to investigate the frequency of the use of methadone in Italian hospices and how it is used.

Methods: The Italian registry of palliative care institutions, named Osservatorio Federazione cure palliative, was consulted at its official website. Phone interviews were planned with physicians who were delegated to provide the answers. Data regarding the hospice and experience of physicians were collected. Questions regarding the attitudes in using methadone were posed, including the frequency of use and how this drug was used.

Results: Of 165 centers contacted, information was available for 138 hospices (83.6 %). The majority of interviewed physicians considered methadone as a difficult drug to use, and only 38 responders (27.5 %) were using methadone as an analgesic in a minority of patients (less than 5 % in more than half of responders). When methadone is used as first opioid, all the patients receive less than 10 mg/day. Almost all physicians switched from morphine to methadone and used a conversion ratio inversely proportional to the morphine dose.

Conclusions: Physicians working in hospices should improve the knowledge regarding the use of opioids, including methadone, as well as complex treatments which can be the principal reason for hospice admission.