According to Medscape, opioid analgesics account for more drug-related medical malpractice claims in Columbus, Ohio, and throughout the U.S. than any other class of drug. Though opioids accounted for only 5% of drugs dispensed in 2016, they were involved in 24% of medication-related claims. Overdose was the primary trigger for a medical malpractice claim, followed by addiction.
In more than one-third of opioid-related claims, the mistake seemed to occur during the follow-phase of prescribing. In many cases, the physician continued to renew a patient’s prescription without ever performing a follow-up exam. Even if a follow-up exam reveals that a patient is still in pain, best practices dictate that the doctor remove the patient from the medication, as continued pain is a sign that the drug is ineffective. In 15% of cases, the named physician “behaved inappropriately.” This type of charge typically boils down to a physician renewing a prescription against his or her better judgement and at the pleas of a pill-seeking patient.
According to the MayoClinic, the Centers for Disease Control devised a set of prescription guidelines to which all doctors must adhere when writing and renewing opioid prescriptions. Per the guidelines, doctors must prescribe the lowest effective dose for the shortest period necessary when treating acute pain. Typically, acute pain does not necessitate opioids for more than three days.
Physicians should also avoid prescribing opioids for chronic pain or, at the very least, delay prescription. The CDC warns that opioids are not safe or even very effective for chronic pain, unless said pain is cancer related. Instead, physicians should work with their patients to devise realistic treatment plans and goals that include other forms of therapy, such as physical therapy.
If a doctor determines that a patient truly does need opioids for pain relief, he or she should have the patient sign an opioid therapy agreement. This agreement outlines the patient’s responsibilities while undergoing treatment, as well as detail what he or she should not do (such as abuse the pain relievers or ask another physician for a refill). The prescribing doctor should also schedule regular checkups with patients undergoing opioid therapy and request periodic urine tests and pill counts.
Finally, a prescribing doctor has the duty to help opioid patients come off the drug in a safe manner. When it is time for a chronic pain patient to stop opioid treatment, the physician should have a plan in place designed to minimize potentially severe side effects.