Student Dies While Undergoing Treatment For Opioid Addiction

ByVictoria Negron

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Updated onApril 10, 2018

Student Dies While Undergoing Treatment For Opioid Addiction

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.

Question(s) For Expert Witness

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

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

Expert Witness Response E-068745

inline imageI'm Board Certified in Addiction Medicine, Medical Toxicology and Board Eligible in Internal Medicine. Major components of my practice including treating opioid dependence, toxicity related to opioids, and complex pain/addiction issues in the hospital and clinic setting. I've been Director of Toxicology at a large university medical center for 6 years now and Medical Director for a large Outpatient Treatment program for nearly as long. I have published and lectured extensively on opioid-related topics. Most recently I was a 2nd author of a paper which discussed methadone use. I have consulted on numerous methadone-intoxicated patients, treated them at bedside, and consulted indirectly for a methadone clinic providing feedback/expert assistance and advised on dosing. I have not prescribed methadone for a patient that has resulted in a fatality --I have cared for methadone overdoses in the hospital.

inline imageMethadone-related questions are very common in my clinical and academic practice. 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. Methadone prescription is either for dependence treatment (which is very strict and must follow specific protocol) or for pain management (which results in many more overdose deaths than the clinic use for dependence). In this patient, the prescription involves treatment of dependence -- pain control may be a secondary outcome, though dosing would not be changed to suit pain control.

inline imageMethadone 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 author

Victoria Negron

Victoria Negron

Victoria Negron has extensive experience in journalism and thought leadership in the legal space, with a background crafting content, whitepapers, webinars, and current event articles pertaining to the role of expert witnesses in complex litigation matters. She is a skilled professional specializing in B2B product marketing and content marketing. Currently, she serves as an Enterprise Product Marketing Manager at Postman, and previously held the position of Technical Product Marketing Manager at Palantir Technologies, where she developed her skills in launch strategies, go-to-market strategy, and competitive analysis.

Her expertise in content marketing was further refined during her tenure at the Expert Institute, where she progressed from a Marketing Writer to Senior Content Marketing Manager, and eventually to Associate Director of Content & Product Marketing. In these roles, she honed her abilities in digital marketing, SEO, content strategy, and thought leadership.

Educationally, Victoria holds a Master of Business Administration from the University of Florida - Warrington College of Business and a Bachelor of Arts in Literature, Art, and Hispanic Studies from Hamilton College. Her diverse educational background and professional experience have equipped her with a robust skill set in product marketing, content development, and strategic marketing initiatives.

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