Allegations of Medical Malpractice in Chronic Opioid Analgesic Therapy Possibly Related to Collaborative/Split Treatment and the P-450 Enzyme System: Forensic Case Report

Abstract

A medicolegal forensic case report of allegations of medical malpractice during chronic opioid analgesic therapy is presented. Here, issues relating to split treatment and the P450 enzyme system are discussed. Objectives: The objectives of this forensic medicolegal case report were the following: 1) present details of a patient on chronic opioid analgesic therapy (COAT) where a disastrous outcome resulted in allegations of malpractice; 2) detail the plaintiff's and defendant's medical experts' opinions on this allegation; and 3) discuss issues potentially related to these allegations, i.e., split treatment and the P450 enzyme system. Methods Case Report Results: Medicolegal issues surrounding these malpractice allegations are discussed. Conclusions: Split treatment can increase the difficulties in performing COAT. Clinicians should routinely consider the effects of all utilized drugs on the ability of the P450 enzyme system to metabolize/clear opioids. Wiley Periodicals, Inc.