Methadone Detoxification for Opiate Addiction
DESCRIPTION
Methadone hydrochloride is a synthetic opioid analgesic. It binds to molecular groups within the cells called mu opioid receptors, one of three types of opioid receptors. Heroin and morphine also bind to cellular mu receptors. Methadone has multiple actions similar to those of morphine involving the central nervous system and smooth muscle organs. It satisfies the craving for opiates but it does not provide the euphoric high provided by morphine or heroin. As compared to withdrawal from morphine, an individual undergoing methadone withdrawal experiences a slower onset of withdrawal symptoms, a more prolonged withdrawal course and generally less severe symptoms.
Methadone detoxification is the abrupt and complete discontinuation of methadone. It typically requires a controlled environment with 24 hour medical supervision to manage the symptoms of withdrawal. In this way, methadone detoxification is differentiated from methadone maintenance (continuation of methadone without dosage changes) and methadone tapering (gradual decrease in dosage).
An example of a preparation of methadone hydrochloride is Dolophine® Hydrochloride.
REFER TO DECISION SUPPORT TREE
POLICY
Methadone detoxification for treatment of opiate addiction is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
MEDICAL APPROPRIATENESS
Methadone detoxification for treatment of opiate addiction is considered medically appropriate if ALL of the following criteria are met:
Individual is to undergo detoxification in an inpatient hospital setting
Methadone is abruptly and completely discontinued
The individual manifests signs and symptoms of opiate withdrawal, including, but not limited to, ALL of the following:
Significantly abnormal vital signs
Excessive lacrimation
Nausea
Abdominal cramping
Excessive rhinorrhea
Piloerection
Vomiting
Bone pain
APPLICABLE TENNESSEE STATE MANDATE REQUIREMENTS
Tennessee State law requires coverage of off-label indications of Food and Drug Administration (FDA) approved drugs when the off-label use is relative to life-threatening illnesses, such as cancer, AIDS, and coronary heart disease and recognized in one of the standard reference compendia (As defined in the statute: The United States Pharmacopoeia Drug Information, The American Medical Association Drug Evaluations, & The American Hospital Formulary Service Drug Information) or in the medical literature. This law is applicable to all fully insured members. The law is not applicable to self-funded accounts, but coverage for off-label uses may be provided based on the contractual agreement.
ADDITIONAL INFORMATION
For appropriate dosage information, contraindications, precautions, warnings, and monitoring information, please refer to one of the standard reference compendia (e.g., The American Hospital Formulary Service Drug Information).
Methadone detoxification should be conducted by individuals with experience and knowledge of opioid detoxification protocols. 24-hour medical supervision is necessary during methadone detoxification to prevent serious medical complications associated with opioid withdrawal.
Methadone maintenance (continuation of methadone without dosage changes) and methadone tapering (gradual decrease in dosage) are appropriately provided on an outpatient basis by licensed methadone clinics.
Abrupt discontinuation of methadone may be facilitated by the use of an opioid antagonist. Withdrawal signs and symptoms are treated palliatively, using alpha-antagonists (such as Clonidine), nonnarcotic analgesics, and antiemetics.
No controlled studies were found in the published literature that validate the use of methadone detoxification to be used for other conditions/diseases.
SOURCES
BlueCross and BlueShield Association. Medical Policy Reference Manual. (2:2003). Methadone treatment for opiate addiction. (3.02.01). Retrieved November 13, 2008 from BlueWeb.
Lexi-Comp Online. (2008). AHFS DI. Methadone hydrochloride. Retrieved November 11, 2008 from Lexi-Comp Online with AHFS.
MICROMEDEX Healthcare Series. Drugdex Drug Evaluations. (2008). Methadone. Retrieved November 11, 2008 from MICROMEDEX Healthcare Series.
U. S. Department of Health and Human Services. Substance Abuse and Mental Health Services Administration. (2006, March). Center for Substance Abuse Treatment. Detoxification and substance abuse treatment: A treatment improvement protocol (TIP 45). Retrieved November 20, 2008 from http://download.ncadi.samhsa.gov/prevline/pdfs/DTXTIP45(3-30-06).PDF.
U. S. Food and Drug Administration. (2006, November). Center for Drug Evaluation and Research. Dolophine® hydrochloride label. Retrieved November 13, 3008 from http://www.fda.gov/cder/foi/label/2006/006134s028lbl.pdf.
U. S. Food and Drug Administration. (2006, November). Center for Drug Evaluation and Research. Dolophine® hydrochloride approval letter. Retrieved November 13, 3008 from http://www.fda.gov/cder/foi/appletter/2006/06134s028ltr.pdf.
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EFFECTIVE DATE |
3/25/2009 |
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ID_BT
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
Pharmaceutical Decision Support Tree
Methadone Detoxification for Opiate Addiction
Does the individual have a diagnosis of opiate addiction?
If yes, go to question #2
If no, this does not meet medical necessity and/or medical appropriateness
Is the individual to undergo detoxification in an inpatient hospital setting?
If yes, go to question #3
If no, this does not meet medical necessity and/or medical appropriateness
Is the individual’s methadone abruptly and completely discontinued?
If yes, go to question #4
If no, this does not meet medical necessity and/or medical appropriateness
Does the individual manifest signs and symptoms of opiate withdrawal including, but not limited to, ALL of the following?
Significantly abnormal vital signs
Excessive lacrimation
Nausea
Abdominal cramping
Excessive rhinorrhea
Piloerection
Vomiting
Bone pain
If yes, this satisfies medical necessity and medical appropriateness criteria
If no, this does not meet medical necessity and/or medical appropriateness criteria
This document has been classified as public information.