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Dr Manfredonia is board certified and a Fellow of the American Academy of Hospice and Palliative Medicine.

Address correspondence to John F. Manfredonia, DO, FACOFP, FAAHPM VistaCare Area Medical Director, 6420 E Broadway Blvd, Suite B-200, Tucson, AZ 85710. E-mail: john.manfredonia{at}vistacare.com

Methadone hydrochloride is an effective, inexpensive, and relatively safe opioid to use in treatment of patients with chronic pain. Because it is the only long-acting analgesic available in liquid form, methadone is especially valuable in management of pain during the final stages of life. However, because methadone has an inherently long duration of action with wide variations, a possibility of accumulation and overdosage exists. Therefore, physicians must be judicious and conscientious when prescribing this opioid. Physicians must also closely monitor patients during the titration phase and educate them with regard to basic pharmacologic properties and potential side effects. A plan to start at low doses and proceed slowly is applicable to methadone.