title: Allegations of medical malpractice in chronic opioid analgesic therapy possibly related to collaborative/split treatment and the P-450 enzyme system: forensic case report.
abstract: OBJECTIVE
  The objectives of this forensic medicolegal case report were the following: 1) present details of a patient on chronic opioid analgesic therapy (COAT) where a disastrous outcome resulted in allegations of malpractice; 2) detail the plaintiff's and defendant's medical experts' opinions on this allegation; and 3) discuss issues potentially related to these allegations, i.e., split treatment and the P450 enzyme system. METHODS CASE REPORT RESULTS: Medicolegal issues surrounding these malpractice allegations are discussed.
  
  
  CONCLUSIONS
  Split treatment can increase the difficulties in performing COAT. Clinicians should routinely consider the effects of all utilized drugs on the ability of the P450 enzyme system to metabolize/clear opioids.
authors.affiliation: Department of Psychiatry, Miller School of Medicine, 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
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects / Q000378:metabolism / Q000627:therapeutic use; D002908:Chronic Disease / Q000188:drug therapy; D003577:Cytochrome P-450 Enzyme System / Q000378:metabolism*; D004347:Drug Interactions; D062787:Drug Overdose; D017809:Fatal Outcome; D005554:Forensic Medicine; D006801:Humans; D008297:Male; D008318:Malpractice / Q000331:legislation & jurisprudence*; D008875:Middle Aged; D010098:Oxycodone / Q000009:adverse effects / Q000378:metabolism / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy*
chemical_list: D000701:Analgesics, Opioid; D003577:Cytochrome P-450 Enzyme System; D010098:Oxycodone