title: A review of forensic implications of opioid prescribing with examples from malpractice cases involving opioid-related overdose.
abstract: OBJECTIVE
  To provide a forensic overview and trace common threads among malpractice lawsuits involving patients who overdosed while consuming therapeutic opioids.
  
  
  METHODS
  One of us (LRW) reviewed 35 medical records of patients with chronic pain who overdosed, 20 of them fatally, while consuming therapeutic opioids, leading to lawsuits against physicians for malpractice. The reviews were requested by plaintiff and defense attorneys from across the United States from 2005 to 2009 to ascertain which drug(s) were primarily responsible for each death and whether the death was due to physician error, patient nonadherence, or some other reason. Complaints against pharmaceutical companies were excluded. Cases were examined for common trends, and comment is offered.
  
  
  RESULTS
  Methadone was responsible for the most deaths at 10 (50%), and hydrocodone was second at four deaths (20%) The most common risk factors found in the medical records of decedents included prescriber error in initiating, converting or titrating doses, patient nonadherence to medical instruction, presence of comorbid mental disorders, toxicological presence of benzodiazepines, middle age, and unrelieved pain. This article focuses on examples of physician errors and how they can be prevented.
  
  
  CONCLUSIONS
  Common trends emerge from medical records of opioid decedents. Patient actions con-tribute, but physician error, particularly regarding prescribing methadone for pain, is apparent as well. A focused effort to determine the types and causes of common physician errors and how they might be avoided may lead to safer, more effective clinical interventions in the management of pain.
authors.affiliation: UC Davis School of Medicine, Sacramento, California 95817, USA. barich@ucdavis.edu
authors.forename: Ben A
authors.initials: BA
authors.lastname: Rich
authors.forename: Lynn R
authors.initials: LR
authors.lastname: Webster
mesh_terms: D000701:Analgesics, Opioid / Q000506:poisoning* / Q000627:therapeutic use; D002908:Chronic Disease; D062787:Drug Overdose / Q000401:mortality*; D011307:Drug Prescriptions; D005554:Forensic Medicine; D006801:Humans; D051188:Knowledge Bases; D008318:Malpractice / Q000331:legislation & jurisprudence*; D008499:Medical Records; D008508:Medication Errors; D008691:Methadone / Q000506:poisoning / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy
chemical_list: D000701:Analgesics, Opioid; D008691:Methadone