title: Alleged medical abandonment in chronic opioid analgesic therapy: case report.
abstract: OBJECTIVE
  The objectives of this medicolegal case report were the following: 1) present details of a chronic pain patient (CPP) on chronic opioid analgesic therapy (COAT), who diverted her opioids and was terminated from treatment, and subsequently committed suicide; 2) present both the plaintiff's and defendant's (the COAT prescriber) expert witnesses' opinions as to the allegation of medical abandonment of this patient and other allegations; and 3) based on these opinions, to develop some recommendations as to how pain physicians can minimize their medicolegal risk when termination of the physician-patient relationship is warranted.
  
  
  METHODS
  This is a case report of a CPP treated by a pain physician who demonstrated aberrant drug-related behaviors and required large doses of controlled-release oxycodone.
  
  
  RESULTS
  Differences between the plaintiff's and defendant's experts' opinions are presented by utilizing the COAT literature. Options for avoiding allegations of abandonment are proposed.
  
  
  CONCLUSIONS
  To avoid and protect themselves against potential abandonment allegations when termination of the physician-patient relationship is warranted, physicians are advised to consider following the outlined procedures.
authors.affiliation: Departments of Psychiatry, Miller School of Medicine, University of Miami, 1400 Northwest 10th Avenue (D-79), 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: Rennee Steele
authors.initials: RS
authors.lastname: Rosomoff
mesh_terms: D015746:Abdominal Pain / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D000328:Adult; D000437:Alcoholism / Q000150:complications; D000525:Alprazolam / Q000008:administration & dosage; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D003415:Crime; D004334:Drug Administration Schedule; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D008318:Malpractice / Q000331:legislation & jurisprudence*; D009293:Opioid-Related Disorders / Q000209:etiology / Q000523:psychology; D010098:Oxycodone / Q000008:administration & dosage / Q000009:adverse effects; D010148:Intractable Pain / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D050500:Pancreatitis, Chronic / Q000150:complications / Q000503:physiopathology; D010349:Patient Compliance; D010817:Physician-Patient Relations; D016079:Refusal to Treat / Q000941:ethics / Q000331:legislation & jurisprudence*; D012651:Self Medication / Q000523:psychology; D013405:Suicide / Q000941:ethics / Q000331:legislation & jurisprudence*
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D010098:Oxycodone; D000525:Alprazolam