{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T05:06:04Z","timestamp":1788930364397,"version":"build-2803163510"},"reference-count":20,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2019,9,17]],"date-time":"2019-09-17T00:00:00Z","timestamp":1568678400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Pharmacy Practice"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:p>Methadone is frequently used to prevent withdrawal symptoms secondary to intended therapeutic opiate exposure. Absence of a standardized dose weaning strategy potentially results in increased exposure to narcotics and\/or withdrawal symptoms. We sought to quantify the effect of implementing a standardized methadone weaning protocol and withdrawal assessment tool on methadone exposure and opiate withdrawal in pediatric patients receiving 5 or more days of continuous morphine or fentanyl infusions. The preintervention phase included patients weaned off of opiate infusions before implementation of a standardized weaning protocol and withdrawal symptom scoring tool. Patients in the postintervention phase were started on a standardized methadone wean based on total duration and dose of continuous opiate infusion exposure in the 24 hours preceding methadone initiation. Patients received either a 5- or 10-day wean, with the total daily methadone dose reduced by 20% daily or every other day, respectively. Patients in the postintervention phase were monitored for withdrawal using the withdrawal assessment tool (WAT-1). Postintervention patients were compared to preintervention patients treated with methadone. Total methadone duration decreased significantly from a median of 17 (13-22 interquartile range [IQR]) to 5 (5-10 IQR) days ( P = .00001) after implementation of the methadone weaning protocol. Number of morphine boluses administered increased from a median of 3 (0-6 IQR) to 4 (0-5 IQR) doses per patient ( P = .45). Demographic data were similar between both groups. Patients in the postintervention phase had significant reductions in methadone exposure after implementation of a standardized methadone weaning protocol and assessment tool.<\/jats:p>","DOI":"10.1177\/0897190019875613","type":"journal-article","created":{"date-parts":[[2019,9,18]],"date-time":"2019-09-18T00:51:26Z","timestamp":1568767886000},"page":"417-422","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":14,"title":["Iatrogenic Opiate Withdrawal in Pediatric Patients: Implementation of a Standardized Methadone Weaning Protocol and Withdrawal Assessment Tool"],"prefix":"10.1177","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9351-776X","authenticated-orcid":false,"given":"Ryan A.","family":"Walters","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Joe DiMaggio Children\u2019s Hospital, Hollywood, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Izquierdo","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Joe DiMaggio Children\u2019s Hospital, Hollywood, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Carlos","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Joe DiMaggio Children\u2019s Hospital, Hollywood, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanie Spiro","family":"Stevens","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Joe DiMaggio Children\u2019s Hospital, Hollywood, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald","family":"Lavandosky","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care Medicine, Joe DiMaggio Children\u2019s Hospital, Hollywood, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2019,9,17]]},"reference":[{"key":"bibr1-0897190019875613","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-006-0190-x"},{"key":"bibr2-0897190019875613","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(05)82419-9"},{"key":"bibr3-0897190019875613","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-199405000-00009"},{"key":"bibr4-0897190019875613","doi-asserted-by":"publisher","DOI":"10.1046\/j.1460-9592.2001.00764.x"},{"key":"bibr5-0897190019875613","doi-asserted-by":"publisher","DOI":"10.1067\/mcp.2002.128386"},{"key":"bibr6-0897190019875613","doi-asserted-by":"publisher","DOI":"10.5863\/1551-6776-21.1.54"},{"key":"bibr7-0897190019875613","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0b013e3181fe38f5"},{"key":"bibr8-0897190019875613","doi-asserted-by":"publisher","DOI":"10.1046\/j.1460-9592.2003.01153.x"},{"key":"bibr9-0897190019875613","doi-asserted-by":"publisher","DOI":"10.1097\/00130478-200010000-00005"},{"key":"bibr10-0897190019875613","doi-asserted-by":"publisher","DOI":"10.1097\/00130478-200110000-00009"},{"issue":"4","key":"bibr11-0897190019875613","first-page":"1045","volume":"102","author":"Berens RJ","year":"2006","journal-title":"Paediatr Anaesthes"},{"key":"bibr12-0897190019875613","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0b013e31818c8328"},{"key":"bibr13-0897190019875613","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-200006000-00079"},{"key":"bibr14-0897190019875613","doi-asserted-by":"publisher","DOI":"10.1074\/jbc.272.8.5040"},{"key":"bibr15-0897190019875613","doi-asserted-by":"publisher","DOI":"10.1016\/S0091-3057(01)00757-2"},{"key":"bibr16-0897190019875613","doi-asserted-by":"publisher","DOI":"10.1124\/mol.65.3.492"},{"issue":"2","key":"bibr17-0897190019875613","first-page":"1048","volume":"289","author":"Davis AM","year":"1999","journal-title":"J Pharmacol Exp Ther"},{"key":"bibr18-0897190019875613","doi-asserted-by":"publisher","DOI":"10.4037\/ccn1996.16.6.87"},{"issue":"1","key":"bibr19-0897190019875613","first-page":"38","volume":"15","author":"Miller JL","year":"2010","journal-title":"J Pediatr Pharmacol Ther"},{"issue":"1","key":"bibr20-0897190019875613","first-page":"141","volume":"2","author":"Finnegan LP","year":"1975","journal-title":"Addict Dis"}],"container-title":["Journal of Pharmacy Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0897190019875613","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/0897190019875613","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0897190019875613","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:35:43Z","timestamp":1777509343000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0897190019875613"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,9,17]]},"references-count":20,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2021,6]]}},"alternative-id":["10.1177\/0897190019875613"],"URL":"https:\/\/doi.org\/10.1177\/0897190019875613","relation":{},"ISSN":["0897-1900","1531-1937"],"issn-type":[{"value":"0897-1900","type":"print"},{"value":"1531-1937","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,9,17]]}}}