A Review of Forensic Implications of Opioid Prescribing with Examples from Malpractice Cases Involving Opioid-Related Overdose

Abstract

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.

KSA-Self Assessment of Pain Management Medication Safety for Hospitals

“…As a result, many of incidents occurred of medication error events or adverse reaction or even fatal occurrence that's conclusion of the safety of pain management medication not compromised. [1][2][3][4][5][6][7] Problems with pain management can link to absent of complete a structural pain management program with inadequate close patient monitoring. [8][9][10][11][12][13] There is a wide variety of different analgesics available on the market; dosage forms that range from lollipops to patches; the differences of delivery vehicles from implantable devices to patient-controlled analgesia (PCA), and different routes of administration.…”

Pharmacotherapy for Chronic Low Back Pain

“…Benzodiazepines have been recommended for use as muscle relaxants for short-term therapy in both US and European guidelines (Airaksinen et al, 2006;Chou et al, www.intechopen.com Pharmacotherapy for Chronic Low Back Pain 127 2007). These anxiolytics have a high risk of addiction and abuse, and their combined use with opioids is of particular concern (Rich & Webster, 2011).…”

Electronic Pharmacopoeia: A Missed Opportunity for Safe Opioid Prescribing Information?

“…Although diversion from appropriate use is the primary contributor, errors in therapeutic prescribing remain a consequential cause of unintentional opioid overdose, patient morbidity and mortality, and medicolegal liability [3]. Prescribing errors occur for many reasons, but many relate to the intricacies of using newly marketed opioids, including reformulations of existing medications and the need for attentiveness to contraindications and drug interactions [3,4].To aid in the prevention of prescribing errors, many physicians and health systems rely on the use of computerized prescription order entry programs (CPOE) that provide decision support [5]. While these programs are able to identify many aberrant orders and reduce medication errors, there are certain limitations that are shared with the legacy systems of handwritten orders.…”

“…-Mark Twain (1835Twain ( -1910 Morbidity and mortality resulting from prescription opioid use has reached epidemic proportions in the United States [1,2]. Although diversion from appropriate use is the primary contributor, errors in therapeutic prescribing remain a consequential cause of unintentional opioid overdose, patient morbidity and mortality, and medicolegal liability [3]. Prescribing errors occur for many reasons, but many relate to the intricacies of using newly marketed opioids, including reformulations of existing medications and the need for attentiveness to contraindications and drug interactions [3,4].…”

“…While these mobile applications allow physicians to carry a wealth of information in a convenient, rapidly accessible, and updatable package, design constraints such as screen size and user interface layout may result in separation and compartmentalization of important prescribing information and relevant warnings. Because errors in prescribing are the largest contributor to adverse medication events [3], pharmacopoeia, to be clinically valuable, should simultaneously meet the need to instantly access accurate dosing data as well as present the prescriber with warnings that support safe prescribing practices without compromising the overall accessability of the application's user interface [9].…”