Is misdiagnosis of opioid addiction a valid cause for peer review?

[drusso]

Curious what is the group consensus?

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[101N]

Type 1 error or type 2. Type 2 could be fatal.

 

[willabeast]

peer review is not always a bad thing. many cases are judged to be favorable to the defendant. when they are not, they usually help someone make better decisions in the future. unfortunately bad outcomes do influence decisions although they shouldn't. and docs reputations influence decisions also - and should not.
but reviewers are human. and sometimes stupid. at least the reviewers usually went to medical school.

 

[Aether2000]

The terminology becomes critically important in any peer review, board or legal action given that "addiction" is not a clearly defined diagnosis. It is like pornography- you know it when you see it, but trying to define it is difficult. Opioid use disorders under the DSM-5 consist of:

Opioid Use Disorder Criteria:
A minimum of 2-3 criteria is required for a mild substance use disorder diagnosis, while 4-5 is moderate, and 6-7 is severe (APA, 2013). Opioid Use Disorder is specified instead of Substance Use Disorder, if opioids are the drug of abuse. Note: A printable checklist version is linked below

1. Taking the opioid in larger amounts and for longer than intended
2. Wanting to cut down or quit but not being able to do it
3. Spending a lot of time obtaining the opioid
4. Craving or a strong desire to use opioids
5. Repeatedly unable to carry out major obligations at work, school, or home due to opioid use
6. Continued use despite persistent or recurring social or interpersonal problems caused or made worse by opioid use
7. Stopping or reducing important social, occupational, or recreational activities due to opioid use
8. Recurrent use of opioids in physically hazardous situations
9. Consistent use of opioids despite acknowledgment of persistent or recurrent physical or psychological difficulties from using opioids
10. *Tolerance as defined by either a need for markedly increased amounts to achieve intoxication or desired effect or markedly diminished effect with continued use of the same amount. (Does not apply for diminished effect when used appropriately under medical supervision)
11. *Withdrawal manifesting as either characteristic syndrome or the substance is used to avoid withdrawal (Does not apply when used appropriately under medical supervision)

*This criterion is not considered to be met for those individuals taking opioids solely under appropriate medical supervision.

A person with an opioid use disorder known to the physician or having signs/symptoms documented but unrecognized coupled with an "event" (OD, doctor shopping, etc) may be cause for counseling of the physician and a warning given. If there is a death if such is known to the physician, it is increasingly likely the physician will be investigated anyway by other entities (or at least a sentinel event sequence should be instituted), however if not, peer review is indicated.

A doctor not recognizing the OUD and not documenting any signs and symptoms of such should not face peer review, unless other doctors have noted clear evidence of OUD. Addiction is not a term that can be easily applied since it lacks a standard definition, and the term addiction should not be used by itself to describe patient behaviors. "The patient had OUD/addiction" is appropriate whereas "The patient was an addict" may not be.