Effectiveness of the buccal mucosa route for methadone administration at the end of life.

BACKGROUND: Methadone is a useful analgesic for neuropathic and nociceptive pain. However, there is little information about the use of methadone in the final days of life when a patient cannot swallow, discouraging its use by many palliative care physicians.

OBJECTIVE: The purpose of this study was to investigate the effectiveness of switching patients on oral methadone at the end of life to methadone by the buccal mucosa route.

METHODS: This is a case series comprising 36 patients on the Toronto Grace Palliative Care Unit (PCU) who took methadone between 2010 and 2012. Their health records were retrospectively reviewed. When patients could no longer swallow at the end of life, oral methadone was replaced with methadone solution in a concentration of 10 mg/mL, placed in the space between the buccal mucosa and lower molars.

RESULTS: Twenty-five patients met inclusion criteria for the series. Twenty-four (96%) of the patients tolerated methadone by the buccal route and were able to continue receiving it that way until they died. Methadone was discontinued by the buccal route in one case (4%) because of intolerance to having medication placed in the oral cavity. Of the patients who remained on buccal methadone, there was a need to increase the dose in two patients with the remaining patients taking the same dose of buccal methadone until they died.

CONCLUSION: The cases reviewed suggest that methadone is well tolerated and effective when switched to the buccal route in patients at the end of life on a palliative care unit.