Posted on: January 10th, 2014
As of February 1st, 2014 the formulation of methadone dispensed from pharmacies in BC will change from a compounded 1mg/ml solution dispensed as a orange flavored drink, to a standard 10mg/ml, cherry flavored liquid called Methadose®. The new solution is 10 times more concentrated than the methadone being used now, so a smaller volume will be dispensed to patients.
The other change to note is that ‘carries’ will no longer be diluted, but will be dispensed in small, child-proof bottles; each containing a daily dose of the cherry-flavoured liquid. Despite the smaller volume, the effect of Methadose®is the same as the methadone currently being compounded.
Methadose®is not new; it has been used in the US since the 1970’s, and has been available in Canada since 2012. BC is switching to cherry-flavoured Methadose® for several reasons:
- Longer shelf life
- Improved quality control
- Ensure consistent dosing
- Eliminates the need to refrigerate (when undiluted)
- Painful if injected
Alberta has been using Methadose® since September 2013, but pharmacies may dispense carries diluted in an orange-flavoured drink. BC will be dispensing Methadose® undiluted which is worrisome as it could increase the likelihood of overdose due to:
- Difficulty in titrating dose changes
- Diversion (i. e. consumed illicitly without a prescription, less likely to be aware of 10-fold higher concentration)
- Accidental ingestion by a child. Methadose®looks like Children’s Tylenol®, and a small amount (1 mL) is enough to cause death in children.
A recent article in the Globe and Mail also discussed the concerns of overdose due to the upcoming switch to Methadose®.
Raising public awareness of the change in formulation is crucial at this time. Dispensing pharmacists and physicians have been receiving training about the switch to Methadose®, and posters are being developed to inform patients, but there is concern that the information may not be reaching all members of the public.
Methadone is an oral long-acting synthetic opioid which is effective in treating opioid dependence. The BC methadone maintenance program has 14,572 registered patients that receive an internationally recognized treatment for opioid dependency.
For more information, refer to updates from:
- College of Pharmacists of British Columbia -(NEW: Update 2)
- College of Physicians and Surgeons of BC
- BC Ministry of Health Information Bulletin
- BC Drug and Poison Information Centre
- Fraser Health - Methadone Alert
- BC Medical Journal - New methadone dosing - overdose dangers
- Island Health - Medical Health Officer's Newsletter
- Vancouver Sun: Changes to methadoen prescribing announced
- Times Colonist:10-times-stronger methadone replacement sparks overdose fears
- 24-hours Vancouver: BC Government warns of super strong methadone
- CFJC TV (Kamloops): Methadone administration changes (video)
- The Province: New methadone formulation will be introduced in BC on Feb 1
- The Townsmen (Cranbrook): Changes to methadone formula coming Feb 1.
- Megaphone Magazine (Vancouver): Heavy measures: Overdose risk as methadone in BC gets stronger
- Global News: New methadone formula will be dispensed starting February 1
Note: Additional links will be added as more information becomes available so please check back for updates