Reducing the Risk of an Addiction or Overdose Claim
By Jennifer Lewis
When was the last time you learned that one of the patients under your care had overdosed on a prescription drug? Deaths as a result of overdose have risen for the eleventh year in a row according to federal data, with the majority of these related to prescribed drugs. The latest figures available from 2010 showed that there were 38,329 fatal drug overdoses, up 3.6% on the previous year and three times the rate seen in 1990. With the rise in the number of patients taking an overdose each year, more doctors are finding that they are on the receiving end of litigation, with individuals or their families believing that their physician is responsible for the event, whether or not the overdose was intentional, as they had prescribed the medication.
Examples of claims
Not only are such cases filed, but some doctors are found to have been negligent, resulting in big payouts. For example, a case in Alabama in
2012 where a husband sued his wife¹s family physician after she suffered an unintentional fatal overdose when taking prescribed narcotics and depressants of the central nervous system was awarded $500,000. In another case last year, close to $2 million was paid out to a woman who suffered brain damage after she received an over-prescription of methadone.
Reducing the risk
Worried about possible drug abuse claims against them, some doctors shy away from prescribing controlled drugs. However, this is often not a realistic option, particularly due to the scarcity of pain specialists, with many doctors working within primary care finding that they have no choice in the matter. While restrictions on prescriptions and refills have been put in place in some medical facilities due to the growing number of overdose cases, doctors need to take precautions individually. You need to be confident that a prescription is appropriate and that your patients are not abusing the controlled substances prescribed to them.
Updating your knowledge
If you prescribe controlled substances, ensure that you keep up to date with current prescribing guidance. With regards to opioids, updating your knowledge has recently been made easier. The FDA ruled that pharmaceutical companies manufacturing opiods must fund continuing professional development for doctors who prescribe them, though these are not mandatory for doctors and other prescribers to attend. The American Medical Association has also made available a series of free webinars relating to opioid prescribing. However, it is not just opioids that pose a risk when it comes to addiction and overdose, so physicians need to be competent with regards to the prescription of any drugs, as certain anti-depressants and anxiolytics pose just as much a danger. A classic example is Xanax, which is the most addictive of the benzodiazepines claimed to be more addictive than heroin – and known in some cases to be associated with a risk of suicide.
While effective Xanax addiction treatment is available, as with any other addictive substance, it is important to avoid the need for this in the first instance.
If screening tools are not currently in place when you prescribe medications known to be addictive, these should be implemented to identify those patients at risk of addiction before you even issue the first prescription. The National Institute on Drug Abuse advises physicians ask everyone about their drug use both past and present – including type and quantity of substances taken, which should be used in conjunction with medical records to assess medical history and their risk of medication abuse. It¹s never possible to be certain who might be prone to misuse drugs, so it is important to screen all patients who are to be considered for prescription of addictive substances, not simply those that fit the stereotype of a typical addict.
It is important to appreciate that patients might be dishonest with respect to their symptoms and their need for relief from this in order to receive further medication, taking advantage of doctors who trust what they are told. While you shouldn¹t doubt every patient, monitoring of addictive medications certainly needs to be in place. Urine testing can be used to confirm whether prescription drugs are being abused and some centers currently use this when deciding whether to increase the dose or issue a new prescription.
Communication and documentation
As with any area of medicine, good communication is vital. It is important that from the outset you discuss the risk of addiction with patients and the dangers of sharing prescribed drugs with others, so that they are fully informed and make clear that the aim of treatment is for short term, rather than long term, use to avoid dependency on the drugs. In some facilities, it is not unknown for doctors to require their patients to sign a contract acknowledging that care will be terminated if they abuse the drugs prescribed to them. If you have concerns that a patient is at risk or is abusing prescription medication, these need to be discussed with the patient. However, it is also important to share your concerns with other physicians and the pharmacist; they too may share your worries, and if they are more experienced, can provide guidance on how best to proceed. Equally, even if addiction is not the issue, but you are unsure with regards to drug interactions or dosage in more complex patients, seeking supervision from more senior or specialist medical staff on the issue is essential.
Communication doesn¹t end with verbal contact. It is important that your documentation regarding prescribing is always clear and complete, and should meet the requirements set out by the state you practice in. If a case were to be filed against you in the event of addiction or overdose, having a record of exactly what happened and that you followed appropriate procedure, including liaison with more specialist physicians, will help your defense.
While you won¹t always be able to prevent cases where a patient becomes addicted to their medication or takes an overdose, implementing the steps discussed here provides you with the best chance of avoiding the risk of that and an ensuing claim.