Emergency Medicine Physician Prescribes Fentanyl Patch to Addict

This case involves a twenty-six-year-old male patient who became addicted to prescription medication after a history of opioid treatment for chronic lower back pain. The addiction became so severe that he began traveling from hospital to hospital requesting pain patches. In most cases, he was turned away and given alternative therapeutic treatments and suggestions for drug abuse counseling. On a final attempt at a remote hospital, where he was unknown to staff, the individual was prescribed a 100mcg Fentanyl Duragesic patch. He was sent home with the patch on his body and a second patch for use, as needed. Immediately upon his arrival at home, he drank a bottle of vodka, took six Vicodin pills, and smoked shavings from the second Fentanyl patch. He became unconscious shortly after the imbibement and went into cardiopulmonary arrest. The cause of death was determined to be an overdose.

Question(s) For Expert Witness

  • 1. What protocols are followed to prevent disbursement of drugs to drug-seeking patients?

Expert Witness Response

Patients often reveal their drug habits through their behavior. They tend to be obsessive and impatient, calling repeatedly both during and after office hours. They manage to find physicians’ home phone and pager numbers. It can be more difficult for an emergency room physician to pick up on such behavior if they are only seeing the patient for the first time and this is where a detailed physical exam may prove to be important in determining drug-seeking behavior. All aspects of the physical exam should be internally consistent. Posture, point tenderness, percussion tenderness, passive and active range of motion, as well as active resistance should tell the same story. Faking the injury in a consistent way is a relatively difficult task for most patients. This becomes even more difficult if the physician uses distraction techniques such as firmly palpating a non-injured extremity while gently palpating the injured extremity.


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