John Tisdale died in 2000 of methadone poisoning, a fact unopposed Tuesday at the outset of a wrongful-death jury trial in federal court.

But the disagreement over whether Roanoke pain doctor Cecil Knox should ever have prescribed the drug to Tisdale is at the heart of the case, which is expected to run through Thursday.

Deloris Tisdale, John Tisdale's widow, is seeking $1.55 million in damages for claims that Knox's negligence led to her husband's death at age 46.

Tisdale's attorney, Tony Russell, told jurors in his opening arguments that John Tisdale had suffered only minor back problems before a car crash Jan. 27, 1999.

After that, John Tisdale visited several doctors for knee pain and lower back pain that radiated into his right leg and upper body. He was first prescribed Percocet, then Celebrex, before an orthopedic specialist told him to return to work and follow up with him in four to six weeks, Russell said.

But Deloris Tisdale, already a Knox patient, recommended Knox to her husband, Russell said. He argued that Knox put John Tisdale on the opium-based drug OxyContin, then the narcotic methadone, without giving the patient a full work-up.

Russell asserted that Knox also increased the dosages "without ever trying to find out what the problems were."

Russell said that when Tisdale died, no illegal drugs were detected in his system, only methadone and alcohol. He said Knox never told Tisdale that he should not drink with the medications.

"Had it been worked up, this was a condition that more than likely could have been treated without these medications," Russell said.

But in his opening argument, Knox's attorney, Powell Leitch, said John Tisdale had serious pain problems before and after his crash, and that Knox spent a lot of time talking to Tisdale and examining him.

Leitch said jurors would hear that John Tisdale was not on a large dose of OxyContin or methadone, and that Knox was tapering the patient off OxyContin. Under Knox's care, John Tisdale was back at work and had achieved functionality, Leitch said.

He added that Deloris Tisdale would likely testify that her husband worked until about 6 p.m. the evening before his death, then had a couple of beers and went to bed. But a family friend will testify that Deloris Tisdale told him her husband spent the entire day before his death drinking beer and taking pills, Leitch said.

"Dr. Knox didn't cause Mr. Tisdale's death by something he did. Mr. Tisdale caused his own death by something he did," Leitch concluded.

The past few years have been long ones of legal turmoil for Knox, who was at one time facing more than 300 criminal charges in connection with his medical practice.

After a jury acquitted him on half and was hung on the rest in 2003, Knox pleaded guilty last year to three charges. He was sentenced to five years' probation and voluntarily surrendered his license to practice medicine.