Student Dies While Undergoing Treatment For Opioid Addiction

Case Overview

This case involves a college student who died from an opioid overdose. The student had undergone surgery after a sports-related injury, and was prescribed opioids for pain relief. The student became addicted after taking the opioids for a few months and later went in for addiction treatment. The student was prescribed the maximum narcotic dose on the first day of treatment, and the doctor increased the student’s dosage the next day. The student suddenly passed away the following evening from opioid poisoning. A Medical Toxicology expert was sought to discuss the proper dosage levels for narcotics patients.

Questions to the Internal Medicine expert and their responses

What are the proper steps during the initial intake process for new patients like the one described above?

Intake into an opioid treatment program involves a series of patient assessments, exams, interviews, a drug screen, and other information gatherings. Some of the initial intake is program specific (e.g. day/time intake and dosing of methadone). Regulations are based on federal guidelines but also subject to state/additional regulation/oversight depending on locale. Most important is a careful patient assessment.

How do you determine when to increase dosage levels of narcotics for such patients?

Methadone titration involves careful patient assessment and compliance with federal guidelines regarding the rate that methadone can be increased. There are limitations. Dosing on day 1 is limited to 30 mg (increase to 40 mg --one additional 10 mg dose x 1) and then 5 mg every 2 days (or 10 mg over 4 days) increases maximum as titration up occurs.

About the expert

This qualified expert of Addiction Medicine obtained his BS in Psychology and his MS in Organic Chemistry from Iowa State University and his MD from the University of Wisconsin-Madison. He completed his Internship and Residency in Internal Medicine at the Hennepin County Medical Center and his Fellowships in Medical Toxicology and Clinical Pharmacology at the University of California, San Francisco. He is Board Certified in Medical Toxicology, Internal Medicine, and Addiction Medicine. He is a member of several prestigious Addiction Medicine Associations and has 125+ Publications on Addiction Medicine Research. He is currently the Associate Fellowship Director for the Combined Addiction Program, an Associate Professor of Public Health and the Director of Toxicology for a Medical University in New York.