A review of forensic implications of opioid prescribing with examples from malpractice cases involving opioid-related overdose

Ben A Rich, Lynn R. Webster

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Objective. To provide a forensic overview and trace common threads among malpractice lawsuits involving patients who overdosed while consuming therapeutic opioids. Methods. One of us (LRW) reviewed 35 medical records of patients with chronic pain who overdosed, 20 of them fatally, while consuming therapeutic opioids, leading to lawsuits against physicians for malpractice. The reviews were requested by plaintiff and defense attorneys from across the United States from 2005 to 2009 to ascertain which drug(s) were primarily responsible for each death and whether the death was due to physician error, patient nonadherence, or some other reason. Complaints against pharmaceutical companies were excluded. Cases were examined for common trends, and comment is offered. Results. Methadone was responsible for the most deaths at 10 (50%), and hydrocodone was second at four deaths (20%) The most common risk factors found in the medical records of decedents included prescriber error in initiating, converting or titrating doses, patient nonadherence to medical instruction, presence of comorbid mental disorders, toxicological presence of benzodiazepines, middle age, and unrelieved pain. This article focuses on examples of physician errors and how they can be prevented. Conclusions. Common trends emerge from medical records of opioid decedents. Patient actions con-tribute, but physician error, particularly regarding prescribing methadone for pain, is apparent as well. A focused effort to determine the types and causes of common physician errors and how they might be avoided may lead to safer, more effective clinical interventions in the management of pain. Wiley Periodicals, Inc.

Original languageEnglish (US)
JournalPain Medicine
Volume12
Issue numberSUPPL. 2
DOIs
StatePublished - Jun 2011

Fingerprint

Malpractice
Opioid Analgesics
Physicians
Medical Records
Methadone
Patient Compliance
Hydrocodone
Pain
Lawyers
Pain Management
Benzodiazepines
Mental Disorders
Chronic Pain
Pharmaceutical Preparations
Toxicology
Therapeutics

Keywords

  • Chronic pain
  • Legal liability
  • Medical malpractice
  • Methadone
  • Mortality
  • Opioid-related overdose

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

A review of forensic implications of opioid prescribing with examples from malpractice cases involving opioid-related overdose. / Rich, Ben A; Webster, Lynn R.

In: Pain Medicine, Vol. 12, No. SUPPL. 2, 06.2011.

Research output: Contribution to journalArticle

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abstract = "Objective. To provide a forensic overview and trace common threads among malpractice lawsuits involving patients who overdosed while consuming therapeutic opioids. Methods. One of us (LRW) reviewed 35 medical records of patients with chronic pain who overdosed, 20 of them fatally, while consuming therapeutic opioids, leading to lawsuits against physicians for malpractice. The reviews were requested by plaintiff and defense attorneys from across the United States from 2005 to 2009 to ascertain which drug(s) were primarily responsible for each death and whether the death was due to physician error, patient nonadherence, or some other reason. Complaints against pharmaceutical companies were excluded. Cases were examined for common trends, and comment is offered. Results. Methadone was responsible for the most deaths at 10 (50{\%}), and hydrocodone was second at four deaths (20{\%}) The most common risk factors found in the medical records of decedents included prescriber error in initiating, converting or titrating doses, patient nonadherence to medical instruction, presence of comorbid mental disorders, toxicological presence of benzodiazepines, middle age, and unrelieved pain. This article focuses on examples of physician errors and how they can be prevented. Conclusions. Common trends emerge from medical records of opioid decedents. Patient actions con-tribute, but physician error, particularly regarding prescribing methadone for pain, is apparent as well. A focused effort to determine the types and causes of common physician errors and how they might be avoided may lead to safer, more effective clinical interventions in the management of pain. Wiley Periodicals, Inc.",
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