Ok, so im doing this case study regarding a minor who escaped a detention center and was brought to a hospital following an automobile accident. He claimed to be suffering from drug withdrawals. He needed blood but refused. The doctor prescribed 40mg of methadone. He was found dead the next morning. Would the doctor be liable for taking the patients word for it?
Dentist Lady
Patients have the right to refuse treatment at any time, though when they refuse they usually sign a refusal form, so unless the patient signed a refusal form the doctor could be liable.
Sparrow
The Harrison Drug Act of 1914 made it illegal for a general practitioner or physician to prescribe methadone for opiate addiction, The only physicians who can prescribe it for that purpose are those running a state certified methadone maintenance clinic.
It is legal, however, for a physician to prescribe methadone for chronic pain management. B/c methadone is a time released medication it only needs once daily dosing, and it does not create a tolerance that requires increases in doses for this reason it works well in those with chronic illness, terminal disease,or chemo.
Unfortunately, while MMT clinics prescribing for opiate addiction must follow strict regulations, regular physicians prescribing for pain do ot and thus, we have a myriad of mishaps in which it is improperly prescribed, and leads to medical issues. While methadone itself is a relatively safe drug when taken as prescribed, it's propensity for being time released makes it dangerous in the hands of those who are unaware. Many will assume b/c they feel no buzz they need to take more, or combine it with other meds or alcohol, and this is extremely dangerous (methadone, contrary to popular belief, does NOT impair motor or Cognitive function when taken in therapeutic doses).
The saddest part is, it's not the physicians and the pain management patients who suffer for this kind of malpractice and negligence it's those who have found sobriety with MMT who suffer. We make good scapegoats.
MMT clinics have a number of failsafe's in place to prevent anything like this: clients entering treatment are always started at a dose of 20 to 30mg, TOPS, regardless of their size, or drug use. From there, they are given incredibly small increases (1-5mg) every 1-2 weeks, IF NEEDED until the patient is stabilized. Stabilization is determined first by the patient~ an absence of acute opiate withdrawal symptoms~ and secondly, by a blood test called a peak and trough, which measures the methadone's serum levels in the system, and determines if the dose is adequate, too high, or too low.
In addition, MMT clinics require patients come in 7 days a week, 365 days a year, and be dosed by an RN; only after a lengthy period of total compliance will they begin to earn take homes and even then, those are given in 1-2 day increments. Some states allow more, but those are given only after years of total compliance.
Total compliance includes: frequent, random, supervised drug testing; annual physicals and blood work, monthly counseling and group therapy. In addition, clinic do not allow clients to drink alcohol, or use other meds that can interact with the methadone. ANY med, prescribed or OTC, must first be approved by the physician, or the client will be considered "dirty" and possibly removed from the program.
Methadone is THE most successful opiate abuse treatment. There are however, many other meds that ca be used to treat withdrawal symptoms; and any hospital ER would be far more likely to prescribe those meds before methadone. In fact, most hospitals cannot administer methadone, even for admitted patients, for a period of more than 3 doses, and only then, with a long line of bureaucratic red tape that is supported by an MMT clinic physician's signature.
Odds are, the story you've heard is just that a story. Part of the fundamental propaganda that has made it's way into the MMT mainstream in an attempt to stop it's use for opiate therapy. Fortunately, those who are responsible thus far have demonstrated a modicum of intelligence and taken the time to study the pharmacological ramifications of MMT.
If however, this is a true story, then it's a sad, sorry, rare thing that should be brought to light. The bulk of the deaths you hear about that are related to methadone are 100% the result of uneducated physicians prescribing it; NOT MMT clinics. Drug abusers misuse the drug and that's why it's vital we protect it for those who are seeking sobriety through it.
Of course, to the public, a recovering heroin addict makes a far better culprit than a a physician when you want to point the finger but MMT clients with methadone take homes are hardly likely to sell theirs since it would mean severe withdrawal. Methadone blocks the receptors opiates bind to, so using heroin will not keep them well if they sell their methadone. Its generally those receiving it for pain management from physicians (NOT MMT Clinics) who are the ones selling it on the black market.
Most opiate addicts in recovery with MMT fully support these strict regulations, and strongly believe they should be initiated for ALL prescribing uses of methadone~ because without them, we know we may be the ones who lose.
So, to answer your original question: a physician prescribing it for withdrawal would indeed be negligible, and complicit in not only medically negligent manslaughter, but in violating his rights as a physician. The hospital he worked for would also be liable, as they have several channels that such prescribing must go through, all of which would be well aware that such prescribing is illegal.
A few good resources:
http://www.methadone.org/
(NAMA- National Alliance for Medication Assisted Recovery, THE biggest resource and advocates for MMT and Methadone).
http://www.methadonetoday.org/
(Methadone today is a monthly newsletter and advocacy based organizations well versed in the legalities and the pharmacological implications of methadone)
http://www.drugtext.org/library/articles/drucker01.htm
(A brief dissertation on the origin of opiate based addiction treatment)
http://www.naabt.org/laws.cfm
(The National Alliance of Advocates for Buprenorphine Treatment~ while this a site dedicated predominately to the use of suboxone, a newer alternative to MMT, it does have some worth in this particular article, which discusses the Harrison Drug Act I referred to)
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Bella
There is a strong possibility that the doctor could be liable. But Medical Malpractice is very hard to prove so the patient would have to make certain that they have their facts straight prior to filing or they could easily lose the suit.
redfan1971
Surely the doctor would test the patient for opiates, he/she would not just take the patient's word for it.
Orignal From: Would a doctor be liable for malpractice if they administer methadone because a patient claimed withdrawal?
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