Second, compared with the other potentially catastrophic risks associated with methadone, the chance of a fatal arrhythmia is minimal. The side effects and potential complications of opioid use in general far outweigh the marginally increased risk entailed by methadone use (3–4). Not only methadone, but also oxycodone, has been associated with the surrogate outcome measure of a prolonged QT interval, suggesting that the full-fledged earthquake (that is, “recommendations” that in essence become restrictive practice mandates because of the litigious nature of our society) may be just over the horizon (5). Should we then perform serial ECG on every patient who initiates opioid therapy, including on emergency department visits and ambulatory surgical procedures? Or, because the sensitivity of 1 ECG screening is quite low, maybe we need to increase the surveillance interval to every month?