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Heroin Addiction and Related Clinical Problems: 2019, 21, N5 (pages: 41 - 53)

Cardiological Safety in Patients Receiving Methadone Treatment

Farina G., Mungai F., and Starace F.

Summary: Background: Long QT syndrome is a rare, potentially fatal cardiac condition caused by an alteration of the ventricular repolarization process requiring a longer time than normal. The anomalies of the ventricular repolarization are caused by alterations of proteins responsible for the transport of potassium and sodium ions through the membranes of the cardiac cells, which represents a fundamental process for the maintenance of normal electrical activity. Functional alterations of these channels may be genetic, but may be also caused by the action of some drugs. There are many drugs that can potentially cause a prolonged QT interval, methadone is among these drugs. Aim: This paper aims at summarizing the recommendations available and at providing advice to promote safer use of methadone. Methods: A systematic revision of available and internationally acknowledged guidelines for methadone treatment was performed and an analysis of the existing processes within the Healthcare Organization - Department of Mental Health and Substance Abuse (DMHSA) of Modena was carried out. Results: More than half of patients on methadone treatment considered in our sample presented at least one cardiological risk factor. Conclusions: A Care Pathways for methadone treatment was developed in order to guide professionals with the identification of the subjects at higher risk, the choice of safer opioid agonist and the cardiac monitoring of patients in treatment.