The use of methadone in Italian hospices: an updated survey

Background: Methadone is a valuable drug for pain management but his use in palliative care settings is still challenging. The primary objective of this study was to take an in-depth look at the clinical use of methadone in specialized palliative care settings in Italy. Methods: A register of all active hospices in Italy at the time of the study was created by consulting the websites of the National Agency for Regional Health Services (Agenas) and the Italian Federation of Palliative Care (Federazione Cure Palliative). A telephone survey composed of an 18-item questionnaire was then carried out with a member of staff of each facility about the period between January and August 2023. A descriptive, non-statistical comparison was made between the results of the present survey and those obtained from a similar survey carried out in 2013. Results: Of the 275 hospices active at the time of the telephone survey, 160 (58%) responded to the questionnaire and 81 of them (51%) confirmed using methadone in their clinical practice. Questionnaire responses revealed that the perception of operators with regard to methadone has gradually shifted towards a greater appreciation of its strengths compared to the potential difficulties encountered in its use. In fact, the use of methadone increased over a 10-year period from 28% in 2013 to 51% in 2023. Conclusions: The results of the present study highlighted a considerable variability in the use of methadone in clinical practice, in line with literature data. Its use has substantially increased in recent years, but appropriate training of palliative care professionals is still needed to ensure its safe and effective management.