Medical malpractice allegations of iatrogenic addiction in chronic opioid analgesic therapy: forensic case reports.
OBJECTIVE
The objectives for presenting these medico-legal forensic case reports are the following: 1) detail three cases where chronic opioid analgesic therapy (COAT) was alleged to cause iatrogenic addiction and/or re-addiction; 2) detail the plaintiff's and defendant's medical experts' opinions on these allegations; and 3) through analyzing these cases, develop some recommendations for future prevention of such allegations during COAT.


METHODS
Case Reports.


RESULTS
Medico-legal issues surrounding the allegation of iatrogenic addiction were identified in each case.


CONCLUSIONS
Before starting COAT, physicians should obtain and document patient informed consent for the risk of addiction/re-addiction with COAT treatment. Patients with a history of addictions pre-COAT should be placed on adherence monitoring immediately on beginning COAT.
Fishbain
David A
DA
Department of Psychiatry, Miami Veterans Administration Hospital, Miami, Florida, USA. d.fishbain@miami.edu
Lewis
John E
JE
Gao
Jinrun
J
D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects*; D019567:Back Injuries / Q000150:complications / Q000188:drug therapy / Q000523:psychology; D005104:Expert Testimony; D005260:Female; D005554:Forensic Medicine; D006801:Humans; D006853:Hydrocodone / Q000009:adverse effects; D007049:Iatrogenic Disease; D007258:Informed Consent; D017116:Low Back Pain / Q000150:complications / Q000188:drug therapy / Q000523:psychology; D008297:Male; D008318:Malpractice / Q000331:legislation & jurisprudence*; D008875:Middle Aged; D009020:Morphine / Q000009:adverse effects; D009293:Opioid-Related Disorders / Q000523:psychology*; D010146:Pain / Q000150:complications / Q000188:drug therapy* / Q000523:psychology*; D010349:Patient Compliance; D010808:Physical Examination; D020069:Shoulder Pain / Q000150:complications / Q000188:drug therapy / Q000523:psychology; D009626:Terminology as Topic
D000701:Analgesics, Opioid; D006853:Hydrocodone; D009020:Morphine