It seems everywhere you look someone is either suffering from or talking about the opioid crisis.
Opioids are a highly-regulated class of powerful narcotic medications including painkillers like fentanyl, oxycodone, hydrocodone, codeine, and morphine.
Like their illegal cousin, heroin, prescription opioids are highly addictive and can get people hooked on them in as little as one dose. Knowing that, it’s not surprising that, since 2000, over 300,000 people have died from opioid overdoses in the United States alone.
Overprescription/overdose lawsuits
Recently, another lawsuit was filed against an opioid medication manufacturer and a physician. Like some lawsuits before it, it alleges that some drug companies bribe doctors to prescribe opioid medications to patients.
In this most recent case, the plaintiff saw a doctor for six years for pain management related to a spinal injury and cyanide poisoning. The patient alleges that his doctor prescribed unnecessarily high doses of opioids, including a fentanyl spray called Subsys, without telling him about the risks of addiction or overdose.
Informed consent
Under Texas law, a physician or mid-level provider (nurse practitioner or physician’s assistant) is required to obtain informed consent before implementing any treatment, including administering prescription medications. Doctors should also be able to explain the rationale and effects of any medication that they prescribe.
Informed consent includes discussing treatment options, including the risks and benefits of each potential option, as well as the risks and benefits of doing nothing at all. When it comes to prescribing opioid pain medications, informed consent isn’t something that can be brushed by. In Texas, the informed consent conversation between the doctor and patient must include seven points:
(1) diagnosis
(2) treatment plan
(3) anticipated therapeutic results, including the realistic expectations for sustained pain relief and improved functioning and possibilities for lack of pain relief
(4) therapies in addition to or instead of drug therapy, including physical therapy or psychological techniques
(5) potential side effects and how to manage them
(6) adverse effects, including the potential for dependence, addiction, tolerance, and withdrawal
(7) potential for impairment of judgment and motor skills.
As a Houston, Texas medical malpractice lawyer, I’ve represented many patients who explained to me how they were so concerned about opioid addiction that they took the bare-minimum dosages of painkillers possible. Other clients have told me that they wish they had been counseled appropriately because they later developed painkiller addictions that were extremely tough to kick.
Pharmacy education
Prescribing physicians and pharmacies participate in the Prescription Drug Monitoring Program, which has a major purpose of preventing patients from doctor shopping to get multiple narcotic prescriptions.
Before taking any new medication, certainly including any painkiller, I recommend that every patient take advantage of the free pharmacist counseling the Texas law requires pharmacies to offer. This is a good time to ask questions about how addictive the medication might be and symptoms that you should look out for. You should also ask if there is any risk of taking the new medication with other drugs that have been prescribed for you.
Texas law on pain management
Texas Medical Board Rule 170.3 regulates physician management and treatment of chronic pain. This rule was enacted to make it tough for doctors to over medicate patients. Some physicians, though, have found ways to skirt around the rule.
The rule puts doctors on notice that the Texas Medical Board and other authorities will evaluate their conduct in prescribing narcotic painkillers based on a host of requirements.
The doctor must evaluate the patient, which includes obtaining a medical history and physical exam. There must also be a problem-focused exam specific to the patient’s main complaint.
For chronic pain patients, the physician has to document in the medical record the following information:
· the nature and intensity of the pain
· current and past treatments for pain
· underlying or coexisting diseases and conditions
· the effect of the pain on physical and psychological function
· any history and potential for substance abuse or diversion
· the presence of one or more recognize medical indications for the use of a dangerous scheduled drug
The doctor and patient must enter into an agreement for treatment of chronic pain. This is a written pain management agreement that includes a provision requiring the patient to take laboratory test for drug levels, upon physician request. It also states that the doctor has the right to limit refills. The agreement also must specify that anyone pharmacy selected by the patient will be used for prescriptions and refills. By the way, I think this is a great idea anyway, because when patients use only one pharmacy, it dramatically reduces the likelihood of drug interaction errors.
The doctor has to periodically review the treatment plan and the patient’s compliance with it.
Opioid prescription malpractice
When a doctor prescribes opioid medications to patients in Texas without following the laws, regulations, and standard of care, it’s medical malpractice and sometimes may cause a wrongful death. Some comic examples include:
· Writing a prescription for too many pills at once
· Writing a prescription front opioid medication that is known to have a dangerous interaction with another medication that the patient is taking
· Prescribing opioids to a patient with a drug allergy
· Prescribing opioids to a patient with heart problems or low blood pressure
· Prescribing opioids to a drug addict
We are here to help
If you or a loved one has been seriously injured because of poor medical care, click here to send us a confidential email via our “Contact Us” form or call us at 281-580-8800.
All consultations are free, and, because we only represent clients on a contingency fee, you will owe us nothing unless we win your case. We handle cases in the Houston area and all over Texas. We are currently working on medical malpractice lawsuits in Houston, The Woodlands, Sugar Land, Conroe, Dallas, Austin, San Antonio, Corpus Christi, Bryan/College Station, and Waco.
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Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. A member of the board of directors of the Houston Bar Association, he was honored, in 2018, by H Texas as one of Houston’s top lawyers. Also, in 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.
