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Medical Malpractice Allegations of Iatrogenic Addiction in Chronic Opioid Analgesic Therapy: Forensic Case Reports


  • David A. Fishbain MD, FAPA,

    Corresponding author
    1. Departments of Psychiatry
    2. Neurological Surgery
    3. Anesthesiology
    4. Miller School of Medicine at University of Miami
    5. The Rosomoff, Comprehensive Pain & Rehabilitation Center
    6. Douglas Gardens
    7. Department of Psychiatry at Miami Veterans Administration Hospital, Miami, Florida
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  • John E. Lewis PhD,

    1. Departments of Psychiatry
    2. Miller School of Medicine at University of Miami
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  • Jinrun Gao MS, MBA

    1. State Farm Insurance, Bloomington, Illinois, USA
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  • Summary
    Three medico-legal forensic case reports where pain medicine defendants were accused of causing iatrogenic opioid addiction and re-addiction during chronic opioid analgesic therapy are detailed. Issues such as informed consent are discussed in reference to these allegations.

David A. Fishbain, MD, FAPA, University of Miami Department of Psychiatry, 1695 NW 9th Avenue, Suite 3302L (D-79), Miami, FL 33136, USA. Tel: 305/355-9021; Fax: 305/668-0578; E-mail:


Objectives.  The objectives for presenting these medico-legal forensic case reports are the following: 1) detail three cases where chronic opioid analgesic therapy (COAT) was alleged to cause iatrogenic addiction and/or re-addiction; 2) detail the plaintiff's and defendant's medical experts' opinions on these allegations; and 3) through analyzing these cases, develop some recommendations for future prevention of such allegations during COAT.

Methods.  Case Reports.

Results.  Medico-legal issues surrounding the allegation of iatrogenic addiction were identified in each case.

Conclusions.  Before starting COAT, physicians should obtain and document patient informed consent for the risk of addiction/re-addiction with COAT treatment. Patients with a history of addictions pre-COAT should be placed on adherence monitoring immediately on beginning COAT.