Medico-legal rounds: medico-legal issues and alleged breaches of "standards of medical care" in opioid rotation to methadone: a case report.
OBJECTIVE
The objectives of this medico-legal case report were the following: 1) To present an example of a medico-legal problem that developed as a result of a decision to rotate a chronic pain patient (CPP) to methadone in order to taper the CPP from oxycodone; 2) To present both the plaintiff's and defendant's expert witnesses' opinions as to if and where the care of that patient fell below the "standard of medical care;" and 3) Based on these opinions, to develop some recommendations on how, in the future, pain medicine physicians and other physicians should proceed, in order to avoid allegations of breach of "standards of care" when using methadone.


METHODS
This is a case report of a CPP treated at a regional hospital pain clinic. Methadone rotation was used in order to taper the CPP from oxycodone because of addictive disease.


RESULTS
During the rotation process, the CPP expired. This had medico-legal consequences. Expert witnesses differed as to whether methadone caused the death.


CONCLUSIONS
Pain physicians should proceed with caution in using methadone for opioid rotation.
Fishbain
David A
DA
Department of Psychiatry, University of Miami School of Medicine, Florida, USA. d.fishbain@miami.edu
Cutler
R B
RB
Cole
Brandly
B
Lewis
John
J
Rosomoff
R Steele
RS
Rosomoff
H L
HL
D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use; D001344:Autopsy; D002908:Chronic Disease; D003657:Decision Making; D005104:Expert Testimony; D005431:Florida; D006801:Humans; D008297:Male; D008318:Malpractice / Q000331:legislation & jurisprudence; D008508:Medication Errors / Q000331:legislation & jurisprudence*; D008691:Methadone / Q000009:adverse effects* / Q000627:therapeutic use; D009293:Opioid-Related Disorders; D010098:Oxycodone / Q000009:adverse effects / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy*; D018710:Pain Clinics / Q000592:standards*; D011570:Psychiatry; D011787:Quality of Health Care / Q000331:legislation & jurisprudence* / Q000592:standards*
D000701:Analgesics, Opioid; D010098:Oxycodone; D008691:Methadone