(No Way I’m) Using Methadone for Hospice

Methadone should be lumped with the “opioid crisis,” right?

If asked about methadone before working in hospice, one image would have immediately surfaced for me: people lined up at a clinic, anxiously awaiting their dose.

The image included a rundown neighborhood, a mix of scraggly men and weary women angling around a building. There would also be protestors with handmade signs (“Keep drugs away from our children!”). And maybe—if depicted by a Hollywood film—a black and white police cruiser would patrol the street. Those crowding the clinic are lowlifes, bums, and losers, addicted to a terrifying opiate like heroin, but now feeding their vile habits with a “safe,” prescribed substitute.

Grim, eh?

What comes to your mind when you consider methadone?

Maybe nothing.

But if you do have a thought, it probably is based on a movie. It’s a story on the mean streets of New York with old Al Pacino or young Ryan Gosling as a loner cop. If your thoughts weren’t from a film, then it was a 60 Minutes piece, a Law & Order rerun, or a hazy recollection when you were lost in the rundown side of chilly Milwaukee or sunburned Miami searching for a college roommate’s address. Regardless of the source of your fragmented memory, you “know” about methadone: it’s for drug addicts. Sure, people may need a physician’s prescription to get a dose, but it’s not much different than the various illegal or over-prescribed drugs that are currently wrecking far too many lives. Methadone should be lumped with the “opioid crisis,” right?

So . . . when a hospice nurse suggested methadone was a good choice to manage the pain (which is awful and relentless), you might quickly respond with, “No way.”

Or a family member, the one you trust, also quickly said, “No way.”

Or, after the nurse invited you to consider methadone for part of your pain treatment and then left for her next patient, you and your spouse chatted about the option for about 5 seconds and decided, “No way.”

As a narcotic, methadone is an undeniably potent drug; using it on a regular basis will lead to addiction. And that’s the truth.

But you are a hospice patient. If you’re in PAIN, you won’t enjoy a loving conversation with your kids. If you’re in pain, you won’t relax and get any decent sleep at night; at midday, you won’t admire the autumn leaves flickering in the wind through your living room window. When the grandkids visit, you’ll get angry with them or ignore them. With pain, the walls close in on us. When in pain, all that matters is not having pain. Methadone may not reduce the pain, but it’s worth a try. Methadone can be an effective, reliable medication.

No! Those real or cinematic mean street images linger. Those ne’er-do-wells snake around a rundown building. Methadone is not, not, not a medication! It’s . . . it’s what?

For some, methadone is a blunt reminder she or he is now a hospice patient, that doctors determined a cure for her or his illness is no longer possible, and that the length of life is limited. Of course, many patients will resent and resist using methadone. Some will stop the potential discussion about its use for pain management before the nurse finishes his first sentence.

Methadone has practical and personal advantages. Frankly, it’s cheaper than morphine. In whatever form methadone is administered—liquid or pills—the typical patient takes fewer doses than many other “pain killers.” It’s longer acting and usually easier on the body. It’s also, like every drug, not perfect. I heard a nurse recently say, “It can make you loopy.” It simply won’t work for everyone. Nonetheless, for some, methadone is beneficial and effective.

But who cares about the upsides? Regardless of what you’ve read (whether my words, web searches, or those colorful pamphlets the nurses and doctors provided), methadone is like a neon sign flashing on your forehead: I am dying.

I would be scared. Methadone is not familiar and comfortable like aspirin and Ibuprofen. It’s never hyped on commercials with carefree couples striding hand-in-hand along carefree beaches, or pushing perfect babies in strollers, or mowing lawns without breaking into a sweat while a cheery announcer urges you to contact your physician for more information.

But the positive side effect of methadone, for many hospice patients, is imperfectly simple and worth considering . . . better pain management.

I believe (along with the scary feelings I’d have), that using methadone doesn’t mean “giving up,” but that you are prioritizing time with your loved ones. Instead of turning away in pain, you can more likely turn toward your loved ones and continue to create meaningful memories.

(Hospice vigorously protects a patient’s privacy. I’ll take care with how I share my experiences. Any names used are fictitious. Events are combined and/or summarized.)

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  1. I do presentations for groups about spinning and weaving. My favorite part of my presentation is talking about the different fibers. Cashmere is a lovely luxury fiber and makes soft silky sweaters and scarves and the list can go on and on. When I ask where cashmere comes from the responses are rarely close. Of course it is goat hair, cashmere goat hair. I think calling it cashmere was a wise marketing ploy that worked. No one wants to wear a goat sweater.
    Methadone needs a new name. Like you said, I associate it with drug addicts in back alleys. I remember having a conversation with a doctor some 30 years ago where the conversation was flipped as my loved one suffered in terrible pain. ‘They’d given as much medication they could safely give’ and when I suggested something stronger and in those days it was harder to do your homework, no google, the doctor seemed to believe the medication was a bad choice because it addictive. I argued that his best guess for survival was less than a month but he stood his ground. It was a long and terrible 5 days. Hospice was not well known and very limited. So glad people like you and your colleagues are there for us when we need them.

    • Good comment about the name change! I suppose, in a broader sense, the same could be said about hospice. It too has an immediate reaction that is mostly focused on impending death, drugs, and “giving up.” And hey, I didn’t know that about goat sweaters!!!!

    • I can be breezy . . . but with this I hope someone thinks of methadone and senses a positive shift in the “wind.”

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