PainJournal.net
Clinical Journal of Pain for
Healthcare Professionals and Patients
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PainJournal.net Clinical Journal of Pain for Healthcare Professionals and Patients
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CASE STUDIES: DEATH & OXYCONTIN Two cases have occurred in which two of my patients have died while taking Oxycontin. Case Number 1: T.S., seen on December 21, 2000. The patient was referred for neurological exam consultation with a 1½ year history of severe pain in the feet bilaterally and also pain up and into the left hip. The pain was pretty much there all the time without aggravating or alleviating circumstance. The pain level was a 10, four to five days out of thirty with some pain (7-8) every day. The patient had studies done – a Lumbar Spine MRI at a local hospital showing arthritis. He had been on Lorcet 4-5 per day and it didn’t really help the pain. He said he took an illicit Oxycontin with the first relief ever at 40 mg. Psychosocial aspects were not unusual. He had four kids and three stepchildren and a wife that worked for an insurance company. He had not been under psychiatric care. He had a area of the (left) anterior jaw node that was rock-hard. I referred him at that point to have it removed because of the possibility of lymphatic cancer. There was a major consideration for neuritis, he may have had Lyme disease (arthritis and neuritis). Tests were ordered. He had also been followed by a rheumatologist at that point in time. The patient was followed by me until 06/28/01. He was having only some mild problems with sleeping. He was on 80 mg. Oxycontin for pain relief. He was on 1200 mg, Neurontin also. The patient had been seen by a consultant Neurology professor for a second opinion as well. He reduced his Oxycontin from 80 q. 12 to 40 q. 12 in order to go off at my request and was to be seen in one month. The patient’s wife called at 1 month and said he was found in a motel shower that morning after taking a shower at night. He apparently hit his head and died during the night. She did not know whether there was any autopsy done. We noted the potential drug bad outcome case. Later, a friend of this patient came in, who was also my patient with an entirely different problem. He stated to me that this individual he had referred and had gotten Methadone from another pain specialist. The prescription was mislabeled! He was given a bottle of 100 presumably 10 mg and was labeled to take 3-4 every 3-4 hours for pain. The patient had this prescription only one day. It was likely this was a fatal methadone accidental overdose due to mislabeling. We do not know what type of operative outcome there was when he had his lymph node biopsied. Interestingly, the wife demanded the medical records for legal review, the second day after he had died. Case Number 2: S.A., a 45 year old left handed gentleman seen because of severe shoulder pain problems beginning in October of 1999 while working for a textile company. He had an injury with an A-frame falling on him. His pain was a daily 6-10. He had these level of pain thirty days out of thirty. He had prior back injury pain 10-15 years ago. There was no radiating pain from the back in the last 7-8 years. He had some residual weakness of the left leg, said he can’t move it well and claimed he had some disc problems as well as neuropathy. He had been followed by a neurologist at a nearby city when he moved to our area. His left shoulder pain was his main pain along with weakness. He said he can’t pick up 50 pounds like he used to. An MRI of the neck showed only some disc bulges he thought. He did have generalized headaches as well. He was mentally quite clear. On examination, the patient had limited range of motion of the left shoulder and crepitation. There was cervical disc present also by formal previous MRI report. I told him I needed to see the actual MRI showing the cervical disc. There was no physical indication of RSD at this time. I told him he absolutely positively had to see an orthopedic surgeon now because of the crepitation in the shoulder. The patient apparently had been on some Limbitrol. I told him initially that I would not give him anything greater in pain relief than the Ultram. Later, we gave him Oxycontin which he was supposedly taking on a regular basis, with this he got excellent long term pain relief. I was called and told by a police officer three weeks later that he was “still warm”. Apparently, this individual, according to the medical examiner’s investigator, had taken an overdose of Oxycontin, along with heroine, cocaine and a host of other street drugs. Several attempts were made by the apparent self-identified ex-wife and other “insurance agents” to immediately obtain and review his records. We would not release except to an authorized personal representative of the estate. SUMMARY: It is apparent that these two individuals who were utilizing Oxycontin for pain relief, also, unfortunately, utilized other medications. The press had recently launched a huge barrage against Oxycontin and law firms are now advertising in “Gaggle” on the net to take the cases as soon as possible. Neither of these 2 cases was a clear-cut cause and effect Oxycontin use alone caused death. This situation is representative of the hysteria of the times. It is causative of the opophobia we are now dealing with in bonafide patients with significant pain problems who are again not treated. Jacob Green, M. D., Ph.D.
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