The Doctor’s Advocate | First Quarter 2017

Prescription Opioid Abuse Epidemic

Analysis of Medication-Related Claims from The Doctors Company

David B. Troxel, MD, Medical Director, Board of Governors

We reviewed 1,770 claims from The Doctors Company that closed between 2007 and 2015 in which patient harm involved medication factors. In 272 of these claims (15 percent), the medications were narcotic analgesics.

In the context of the current epidemic of opioid-related deaths occurring predominantly among outpatients (OPs), this analysis focuses on claims arising in that setting, rather than on claims arising in an inpatient (IP) setting.

Sixty-four percent of the narcotic analgesic claims (174 claims) were from the OP setting. This setting included:

  • Physicians’ offices and hospital clinics (78 percent).
  • Ambulatory and day surgery (10 percent).
  • Emergency room (9 percent).
  • Patient's home (3 percent).

Methadone (16 percent OP versus 4 percent IP) and OxyContin (9 percent OP versus 3 percent IP) were more frequently involved in the OP setting, whereas Dilaudid (34 percent IP versus 10 percent OP), morphine (24 percent IP versus 15 percent OP), and fentanyl (16 percent IP versus 11 percent OP) were more frequently involved in the IP setting.

Sixty-five percent of the admitting diagnoses for OP narcotic-related claims were pain not otherwise specified (NOS) (24 percent), spine-related pain (22 percent), joint/extremity-related pain (9 percent), mental health issues (6 percent), and drug abuse/dependence (4 percent).

In the OP setting, 82 percent of patient allegations involved improper medication management or treatment (70 percent), wrong dose (9 percent), and wrong medication (3 percent). In the IP setting, these same allegations totaled 62 percent.

Of OP narcotic analgesic-related patient injury claims, 66 percent were classified as high severity* (versus 28 percent for IPs). In 60 percent of these OP claims, death was the most common result of injury. Of the final diagnoses for these OP claims, 84 percent included:

  • Poisoning by methadone, heroin, and opiates/narcotics NOS (76 percent).
  • Drug dependence (8 percent).

Patient contributing factors, which included noncompliance with the treatment plan, failure to follow physician instructions, and failure to keep or make follow-up appointments, were more frequent among OPs (39 percent) than IPs (16 percent), as were communication factors (32 percent OPs versus 20 percent IPs).

Since most IP narcotic analgesic-related adverse events occurred in the patient’s room (70 percent)—often following transfer from the PACU or ICU, where they had been closely monitored—it is not surprising that patient monitoring factors were higher among IPs (43 percent versus 21 percent OPs).


*High severity includes injuries that are permanent and significant or major or grave, as well as those that result in death.


The Doctor’s Advocate is published by The Doctors Company to advise and inform its members about loss prevention and insurance issues.

The guidelines suggested in this newsletter are not rules, do not constitute legal advice, and do not ensure a successful outcome. They attempt to define principles of practice for providing appropriate care. The principles are not inclusive of all proper methods of care nor exclusive of other methods reasonably directed at obtaining the same results.

The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

The Doctor’s Advocate is published quarterly by Corporate Communications, The Doctors Company. Letters and articles, to be edited and published at the editor’s discretion, are welcome. The views expressed are those of the letter writer and do not necessarily reflect the opinion or official policy of The Doctors Company. Please sign your letters, and address them to the editor.

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