Medicolegal rounds: Medicolegal issues and alleged breaches of standards of medical care in a patient motor vehicle accident allegedly related to chronic opioid analgesic therapy

David A. Fishbain, MD, FAPA, John E. Lewis, PhD, Brandly Cole, PsyD, Renné Steele Rosomoff, BSN, MBA, Hubert L. Rosomoff, MD, DMedSc, FAAPM


The objective of this medicolegal case report is to present the details of the case of a chronic pain patient (CPP) who was placed on chronic opioid analgesic therapy (COAT) and was involved in a motor vehicle accident, alleged in litigation to be related to COAT. COAT standards are in a process of evolution, and this process is influenced by recent literature developments. We aim to present both the plaintiff's and defendant's expert witnesses' opinions on whether the defendant physician fell below the "standard" in allowing the CPP to drive. Both the methadone and the driving literature are utilized to explain the defendant's and plaintiff's experts' opinions and the differences between them. Based on these opinions, we have attempted to develop some recommendations on how pain physicians should approach the problem of deciding whether patients should be allowed to drive when on COAT.


chronic pain, intractable pain, opioids, chronic opioid analgesic therapy, driving, motor vehicle accidents, standards of medical care, informed consent, breaches of standards, methadone

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