North Carolina News: Item 2165 - Prescriptions for Methadone at 40 mg Strengths

July 1, 2008 3:39 PM Topics: Prescriptions and Pain management

Reprinted from the July 2008 North Carolina Board of Pharmacy Newsletter.

A number of pharmacists have contacted North Carolina Board of Pharmacy staff to ask whether it is legal to fill a prescription for methadone at a 40 mg strength for treatment of pain. Confusion on this issue is understandable.

On January 1, 2008, manufacturers of 40 mg methadone hydrochloride tablets voluntarily agreed with the Drug Enforcement Administration to distribute these tablets only to facilities authorized to conduct detoxification and maintenance treatment for opioid addiction, and to hospitals. More information on this voluntary distribution restriction is at www.deadiversion.usdoj
.gov/pubs/pressrel/methadone_advisory.htm.

Community pharmacists have reported receiving prescriptions directing the patient to take a total 40 mg dose of methadone for treatment of pain using, for example, four 10 mg strength methadone tablets. Board staff is aware of no absolute legal prohibition on the filling of such prescriptions. Again, the voluntary distribution restriction is directed to the 40 mg strength tablet. Board staff is aware of no statute or rule flatly prohibiting the use of a 40 mg dosage of methadone to treat pain. Of course, pharmacists must – as with all prescriptions for controlled substances – be mindful of their corresponding responsibility to ensure that a prescription for any controlled substance is written for a legitimate medical purpose in the ordinary course of practice.

Moreover, press reports have focused on an upswing in methadone-related overdose deaths, particularly in North Carolina. Accordingly, pharmacists must be vigilant in conferring with patients and prescribers to ensure that a patient-appropriate dose of methadone is being prescribed and administered.