Medico-legal rounds: Medico-legal issues and alleged breaches of "standards of medical care" in opioid rotation of methadone: A case report

David A. Fishbain, R. B. Cutler, Brandly Cole, John Lewis, R. Steele Rosomoff, H. L. Rosomoff

Research output: Contribution to journalArticle

14 Scopus citations


Objectives. The objectives of this medico-legal case report were the following: 1) To present an example of a medico-legal problem that developed as a result of a decision to rotate a chronic pain patient (CPP) to methadone in order to taper the CPP from oxycodone; 2) To present both the plaintiff's and defendant's expert witnesses' opinions as to if and where the care of that patient fell below the "standard of medical care;" and 3) Based on these opinions, to develop some recommendations on how, in the future, pain medicine physicians and other physicians should proceed, in order to avoid allegations of breach of "standards of care" when using methadone. Methods. This is a case report of a CPP treated at a regional hospital pain clinic. Methadone rotation was used in order to taper the CPP from oxycodone because of addictive disease. Results. During the rotation process, the CPP expired. This had medico-legal consequences. Expert witnesses differed as to whether methadone caused the death. Conclusion. Pain physicians should proceed with caution in using methadone for opioid rotation.

Original languageEnglish (US)
Pages (from-to)195-201
Number of pages7
JournalPain Medicine
Issue number2
StatePublished - Aug 15 2003



  • Addiction
  • Chronic pain
  • Drug toxicology screens
  • Expert witness
  • Medico-legal
  • Methadone
  • Opioid detoxification
  • Opioid rotation
  • Standards of medical care

ASJC Scopus subject areas

  • Clinical Neurology

Cite this