New guidelines on opioid’s use for chronic pain, published in the Feb issue of the Journal of Pain, are jointly developed by the American Pain Society and the American Academy of Pain Medicine. Even though the use of methadone for chronic pain has grown considerably, the drug has been linked to prolonged QTc, arrhythmias, and an increasing number of deaths. Consequently, the guidelines recommend that doctors start with low doses of methadone and add on slowly. Never should methadone be prescribed as needed.