Risking addiction

BACKGROUND: A 41-year-old man, Mr C, with a history of back pain attends his GP complaining of severe pain that is limiting his mobility and preventing him from sleeping. Dr A examines him and notes that he has recently ended a course of co-codamol for the same problem. He believes the pain could be caused by a slipped disc and prescribes an anti-inflammatory drug and a muscle relaxant to relive the pain.

Less than a fortnight later, Mr C returns to the surgery again complaining of severe back pain as well as showing signs of depression and anxiety. He is seen by Dr B who prescribes an opiate analgesic as well as an anti-inflammatory and a drug to counter his insomnia. Four days later, Mr C is briefly admitted to hospital with extreme pain where morphine is added to his drug regimen. The following week Mr C returns to see Dr B, still in considerable pain, and the GP prescribes a combination of drugs including morphine.

The following month, Mr C is seen at the surgery by Dr E complaining that he is now addicted to his medication. Attempts to stop taking the pills, he says, resulted in stomach cramps, mood swings and sweating. He reports an extremely low mood, lack of confidence and anxiety. Dr E refers him to a clinic where he receives help in withdrawing from his medication over the course of several months, during which time he resigns from his job due to poor health.

The practice receives a letter from a solicitor acting for Mr C alleging the GPs were negligent in their prescribing, causing Mr C to become drug dependent. Mr C claims the risks of addiction weren’t explained to him and is seeking compensation for loss of earnings, emotional distress and for the services provided by friends and family during his dependency and withdrawal.

OUTCOME/ANALYSIS: The GPs involved in providing Mr C’s care are all MDDUS members. In reviewing the patient’s medical records, the medico-legal advisory team can find no note to confirm he was warned of the risk of addiction when the medication was prescribed. An expert GP opinion is sought and it is confirmed that, despite the relatively short length of time that Mr C was taking the medication, addiction could feasibly have occurred.

The expert is critical of the number of repeat prescriptions issued to Mr C by the practice GPs without consultation. He also highlights Dr B’s poor record keeping and his failure to justify continuing to prescribe morphine. He believes Dr B should have more closely monitored the patient’s response to the medication, but concedes that an ordinary GP would not have expected a patient to become dependent in such a short timeframe.

After further discussion and analysis, it is agreed that the case would be difficult to defend and a settlement is negotiated without admission of liability. The payment takes into account the loss of earnings, the distress caused by the dependency/withdrawal process and the practical and emotional support the patient required during this process.

KEY POINTS

• Clearly explain to patients any risk of addiction relating to prescribed medication. Be sure to note this in the patient’s records.
• Closely monitor and review patient medication, especially where there is a risk of dependency