Cancer Patient Dies from Dilaudid Overdose

Case Overview

This pain medicine case takes place in Minnesota and involves a patient with cancer of the tonsils. The patient required extensive radiation treatment and was cured of cancer. The patient experienced a great deal of pain as a result of the radiation treatments. The patient’s radiation oncologist prescribed liquid Dilaudid to be self-administered through a PEG tube. The patient was opiate naive and was prescribed the maximum dosage for liquid Dilaudid, 5-10mg every 3 to 6 hours. Sadly, the patient overdosed on Dilaudid on the 2nd day of using the medication and was found dead at his home.

Questions to the Radiation Oncology expert and their responses

Do you routinely prescribe liquid Dilaudid to patients who've undergone radiation treatment?

Initiating by prescribing Dilaudid, such as in this case, is a fairly rare practice. I usually prescribe other narcotics first, such as oxycodone 5 mg, every 6 hours as needed. If patients have a bad reaction to oxycodone or morphine, only then do I prescribe Dilaudid. My starting dose of Dilaudid is usually 2 mg, every 4-6 hours as needed.

If so, what precautions are taken to ensure an incident like what's described above doesn't occur?

To prevent incidents such as the one in this case, I document patient instructions on how to appropriately take and safely store the medication, and also print out these instructions for patients to take home with them. These instructions are specific to narcotic pain medications.

Would you rely on another physician (i.e., palliative care, pain management, hematology / oncology, etc.) to prescribe pain medicine in this instance - or would you prescribe Dilaudid, yourself?

In cases in which patients do not respond to a level of narcotic pain medications that I prescribe and require a higher dose than which I am comfortable prescribing, I would then refer them to a pain management expert for further review.

Have you ever had a patient overdose on Dilaudid?

Thankfully, I have never had a patient overdose on Dilaudid.

About the expert

This highly qualified Professor o Radiation Oncology received his medical degree from Northwestern University Medical School. He completed a a residency in Radiation Oncology at the highly regarded Stanford University. He is board certified by the American Board of Radiology. This expert has received numerous honor throughout his career including the Wilhelm K. Roentgen NCI Award for Research. He is a member of several professional organizations such as the American Society for Therapeutic Radiology and Oncology and the American Society of Clinical Oncology. He has published 73 peer-reviewed journal articles and authored 25 book chapters.