Opioid prescriptions, use, misuse, and medical malpractice

I recently spoke with a national reporter who called to ask some questions about the state of medical malpractice in Texas. Specifically, our conversation focused on whether the Texas Medical Board is effective.

I quickly commented that, in my opinion, the Texas Medical Board is largely a worthless joke. I qualified my opinion by noting that there are a few types of matters that the Board takes seriously.

One of them, in my experience and opinion, is not the quality of care provided by Texas physicians. Rather, the Board is majorly concerned with relatively minor infractions like the timely release of patient medical records. Then, one exception directly related to patient care came to mind: The Board’s crackdown on the so-called pill mills.

What are pill mills?

Pill mills are pain management clinics and physician offices that over-prescribe powerful, addictive narcotic opioid pain medications. Many experts believe that these dangerous types of medical practices bear large responsibility for the current opioid crisis that plagues Texas and America. I’ll have to give the Texas Medical Board credit on this one, because it’s been pretty aggressive in addressing the problems of pill mills and over-prescription of opioids.

Opioid medical malpractice

It’s not only the pill mill practices that are negligent in opioid prescriptions. In fact, some well-meaning surgeons and physicians make bad decisions in prescribing opioids for their patients.

Opioid addiction has become such a plague all over the country that the standard care has become very well-defined. Surgeons and physicians have to follow these standards of care any time they prescribe opioid medications:

• Prescribe non-opioid medications when possible, and only after reviewing the patient’s prescription drug monitoring program (PDMP) data. The PDMP program was set up to prevent drug-seeking behavior by patients. The standard care requires checking the PDMP data when starting opioid therapy and at least every three months while treatment is ongoing.

• Only prescribe opioid painkillers when the benefits outweigh the risks.

• When ordering opioids, use them in conjunction with other medical treatments, including nonsteroidal anti-inflammatory drugs (NSAIDs), physical or cognitive behavioral therapy, or other interventions.

• Before prescribing opioids, talk with patients about goals and educate them about the risks of addiction. Make it clear that treatment with opioid painkillers will only continue if there is real improvement in pain and function that outweighs the risk of addiction.

• Educate patients that medical studies have shown that long-term opioid use is not a solution for improving pain or function.

• Ensure that patients are aware of the other serious risks of opioid use. The most serious ones are life-threatening, such as respiratory depression that can lead to brain injury and death.

• The U.S. Centers for Disease Control & Prevention (CDC) recommends that physicians begin opioid treatment with immediate-release prescriptions, rather than extended-release ones. Significant medical research shows that patients have a higher chance of overdose with extended-release opioid medications.

• The CDC guidelines also call for prescribers starting patients with the lowest possible effective dose of immediate-release opioid medications and strictly limiting the number of pills to cover the expected length of time the pain would be present.

• Doctors need to monitor patients closely when ordering opioid painkillers. The CDC recommends re-evaluating the continued use of opioids within one to four weeks of initiating treatment. When the risks outweigh the benefits, the standard care requires tapering the patient off opioids toward discontinuation and ordering non-opioid medications as a substitute.

• Doctors, hospitals, and emergency rooms need to be ready to deal with overdose with the reversal medication naloxone. In some situations where there is a higher risk of overdose, the standard care may require providing patients with naloxone, in case it’s needed.

• As with all other medications, physicians must keep in mind the possibility of drug-drug interactions. For opioids, medical experts recommend that physicians avoid prescribing opioids with benzodiazepines whenever possible. Benzodiazepines are used to treat anxiety, epileptic seizures, and spasms.

If you or a loved one has been seriously injured because of opioid mismanagement by a prescribing physician, then contact a top-rated experienced Houston, Texas medical malpractice lawyer for help in evaluating your potential case.

Robert Painter
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Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.