4. I’m a family physician and I’d like to know if opioid medications can be prescribed for pain relief for a person who is on methadone treatment.

Yes, for acute pain, for example, postoperative pain, a fracture or tooth extraction. A user who is receiving methadone treatment often needs a higher-than-usual dose of opioid pain medication because of his higher tolerance and because the pain may not be relieved by the usual dose. The dose of the opioid will then have to be tapered to prevent withdrawal. In this type of situation, the patient may relapse and abuse the tablets prescribed for him. For all these reasons, a physician who prescribes opioid pain medication and the physician who prescribed the methadone should speak to one another.

For chronic pain, there are alternatives to prescribing opioids. Opioids may be less effective in the long term and there is a potential for abuse. Other approaches include increasing the dose of methadone or taking a non-opioid analgesic, for example, anti-inflammatories and co-analgesics. Alternative approaches, such as physiotherapy and psychotherapy, should also be considered.