title: Alleged breaches of "standards of medical care" in a patient overdose death possibly related to chronic opioid analgesic therapy, application of the controlled substances model guidelines: case report.
abstract: OBJECTIVE
  The objectives of this medicolegal case report are the following: 1) to present details of a chronic pain patient (CPP) who was placed on chronic opioid analgesic therapy (COAT), and subsequently overdosed on multiple drugs, some of which were not prescribed by his COAT physician; 2) to present both the plaintiff's and defendant's (the COAT prescriber) expert witnesses' opinions as to the allegation that COAT prescribing was the cause of death; and 3) based on these opinions, to develop some recommendations on how pain physicians can utilize the use of Controlled Substances Model Guidelines in order to protect the patient and themselves from such an occurrence.
  
  
  METHODS
  This is a case report of a CPP treated by a pain physician.
  
  
  RESULTS
  Differences between the plaintiff's and defendant's expert's opinions are explained utilizing the Controlled Substances Model Guidelines.
  
  
  CONCLUSIONS
  Some CPPs may withhold information critical to their COAT treatment. Application of the Controlled Substances Model Guidelines and the newer Federation of State Medical Boards' policy on opioid prescribing can be helpful in improving patient care and may be helpful in protecting the physician medicolegally.
authors.affiliation: Departments of Psychiatry, University of Miami, Miami,FL 33136, USA. d.fishbain@miami.edu
authors.forename: David A
authors.initials: DA
authors.lastname: Fishbain
authors.forename: John E
authors.initials: JE
authors.lastname: Lewis
authors.forename: Jinrun
authors.initials: J
authors.lastname: Gao
authors.forename: Brandly
authors.initials: B
authors.lastname: Cole
authors.forename: Rennée Steele
authors.initials: RS
authors.lastname: Rosomoff
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000506:poisoning*; D014151:Anti-Anxiety Agents / Q000506:poisoning; D000929:Antidepressive Agents, Tricyclic / Q000506:poisoning; D003975:Diazepam / Q000506:poisoning; D004316:Doxepin / Q000506:poisoning; D062787:Drug Overdose; D005260:Female; D006556:Heroin Dependence / Q000150:complications / Q000188:drug therapy; D006801:Humans; D006853:Hydrocodone / Q000506:poisoning; D008318:Malpractice / Q000331:legislation & jurisprudence*; D008691:Methadone / Q000627:therapeutic use; D003708:Nordazepam / Q000506:poisoning; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D017410:Practice Guidelines as Topic / Q000592:standards*; D012782:Shoulder / Q000473:pathology; D000070599:Shoulder Injuries; D013693:Temazepam / Q000506:poisoning
chemical_list: D000701:Analgesics, Opioid; D014151:Anti-Anxiety Agents; D000929:Antidepressive Agents, Tricyclic; D004316:Doxepin; D003708:Nordazepam; D006853:Hydrocodone; D013693:Temazepam; D003975:Diazepam; D008691:Methadone