The Emerging Field of Addiction Medicine
Addiction medicine is a newly recognised area of science that is growing in prominence. Concerned with the proper treatment of patients with substance use disorders, specialists in this field are uniquely qualified to comment on legal matters involving substance abuse.
Ken Starr MD, a Diplomate of the American Board of Addiction Medicine, offers Lawyer Monthly a look into his field of expertise below.
In brief, what does “addiction medicine” mean in a legal sense?
Addiction medicine is the medical speciality focused on the identification and treatment of patients with substance use disorders. Primarily we focus on chemical dependency involving alcohol, opiates, stimulants, and sedatives. However, some providers also include process addictions like gambling, gaming and eating disorders.
Addiction Medicine is now an approved medical speciality with its own fellowship and training programs. Here in the United States, the speciality of addiction medicine is under the umbrella of the American Board of Preventive Medicine.
Addiction medicine specialists work in a variety of settings. I manage both outpatient and inpatient treatment programs, though some providers will work in jails, institutions, inpatient treatment programs and mental health clinics.
As an expert witness in this field, what do you help jurors and counsel to understand?
I educate attorneys and jurors on the complexities of addiction medicine treatment. Patients with substance abuse issues are people with a challenging chronic medical condition. These patients end up in jail or rehab programs where things do not always go well. Additionally, most have underlying severe mental health problems which can make care even more difficult.
My role is really to explain the “why”, “should have”, “how” and “why not“ regarding the care of these types of patients in different clinical settings. I help them to understand what medications are used in this field and their associated risks. More often than not, patients did not receive medications which are standard of care, and so experienced adverse outcomes.
Patients with substance abuse issues are people with a challenging chronic medical condition.
What sort of cases are you called to advise on?
As a recognised expert in this field, my legal experience has involved matters of family law and custody where one parent may need an independent evaluation or a treatment plan so child custody can be safely determined.
I have been involved in a number of accidental death cases involving jails and rehabilitation programs where there is a question about the care provided. Patients with severe drug abuse problems often have unpredictable outcomes. I can help parties determine if the care provided was appropriate or if there was deliberate indifference or medical negligence.
Outpatient programs are managing more patients with severe substance abuse problems who previously were cared for in residential programs. Due to insurance reimbursements, payers want to see those patients transition down and out of care faster than ever before. As you can imagine, high-risk patients in a lower standard of care setting can have untoward outcomes involving overdose, accidental death and suicide. I assist with the necessary review and testimony related to the appropriateness of treatment.
Cases involving addiction medicine can be quite broad. Some recent cases involve a potential class action lawsuit against a major insurance company for denying care to substance abuse patients; determining the appropriateness of urine drug testing; defending a physician’s practice in malpractice litigation, and helping programs establish best practices as they grow and scale.
Patients with severe drug abuse problems often have unpredictable outcomes.
Until five years ago, addiction medicine was not officially recognised as a specialty. Does the relative newness of the field affect your work?
Yes, it does. As addiction medicine is now a recognised speciality, physicians must have practice hours and pass the written Board Exam to become board-certified. As with other medical specialties, it establishes a baseline standard of competence.
The practice environment is diverse. Substance abuse patients receive care in jails, prisons, hospitals, primary care clinics, outpatient treatment programs and inpatient residential programs. In the past, attorneys may have sought advice from toxicology or internal medicine specialists, but now addiction medicine physicians may be more appropriate in evaluating these cases.
What other challenges do you often face in your role?
Patients with active substance use disorders are complicated. They frequently demonstrate bad judgement, take high risks and have significant comorbidities, underlying mental health problems and unpredictable behaviors. Furthermore, they are being prescribed an array of medications by different types of providers in different settings with little to no standardization of treatment.
Each practice environment needs to be individually evaluated based on its own capability combined with the practice standard at the time, which is rapidly changing. So, the main challenges are evaluating the complexities of the disease process, the lack of standardisation of treatment and the variety of practice settings and coming up with a solid foundation of how patients should be best managed.
Are there any common misconceptions about addiction that you try to dispel?
The main misconception is that addiction is a moral failing. Addiction happens to good people. Addiction happens to smart, professional people from good families. We have had pilots, physicians, nurses, attorneys and just about everyone from all walks of life come into the clinic with substance abuse problems. Especially now that we have good medications, it is not enough to just let people go “cold turkey” and hope for the best.
Do you have any closing comments to make about the importance of addiction medicine as a specialisation for expert witnesses?
Just as attorneys have always looked the best specialist for a particular case, this is no different. The most important thing is for attorneys to know there are addiction medicine specialists out there who can render expertise to assist in these specialised cases.
Ken Starr MD Wellnes Group
107 Nelson St, Arroyo Grande, CA 93420
Tel: +1 805-319-7372
Ken Starr is an authority in the field of addiction medicine and wellness. Since founding his clinic in 2012 after the overdose death of his brother, he has been committed to helping patients achieve lasting sobriety and improve the quality of their lives. Ken utilises medications, supplements and traditional and non-traditional therapies that help people overcome chemical dependency and live the lives they know are possible. His current areas of interest include advancing drug and alcohol detox methods, facilitating long term recovery, IV nutritional programs for optimal health, and men’s health programs.