Addiction Medicine Certification Ethics & Professional Standards 2 — Questions and Answers
Question 1: A patient in your addiction medicine practice discloses that they are a truck driver who has been using opioids without a prescription. What is the most ethically appropriate initial action?
- Immediately report the patient to the DMV without further discussion
- Explore the safety implications with the patient and counsel them on the risks and legal obligations (Correct answer)
- Discharge the patient from your practice to avoid liability
- Prescribe a safer opioid to reduce harm while they continue driving
Correct answer: Explore the safety implications with the patient and counsel them on the risks and legal obligations
The clinician should first explore the situation with the patient, balancing confidentiality with public safety duties and guiding the patient toward safe, legal behavior.
Question 2: Which ethical principle is MOST directly violated when a physician accepts gifts from pharmaceutical companies in exchange for prescribing their addiction medications?
- Autonomy
- Justice
- Non-maleficence
- Fidelity and conflict of interest avoidance (Correct answer)
Correct answer: Fidelity and conflict of interest avoidance
Accepting gifts creates a conflict of interest that undermines the physician's fidelity to the patient's best interests over financial gain.
Question 3: A colleague confides that they have relapsed on alcohol but insists they are still competent to practice. What is the most appropriate course of action?
- Keep the information confidential as it was shared in personal trust
- Encourage the colleague to self-report to the state physician health program (Correct answer)
- Report the colleague directly to the medical board immediately
- Ignore the situation since you did not witness impairment at work
Correct answer: Encourage the colleague to self-report to the state physician health program
Encouraging self-referral to a Physician Health Program (PHP) protects the impaired colleague and patients while offering a supportive, confidential pathway.
Question 4: Under 42 CFR Part 2, patient records from substance use disorder programs may be disclosed without patient consent in which of the following circumstances?
- To a treating physician in a general hospital emergency situation involving immediate threat to life (Correct answer)
- To a health insurance company for billing purposes
- To law enforcement conducting a routine drug investigation
- To an employer requesting a fitness-for-duty evaluation
Correct answer: To a treating physician in a general hospital emergency situation involving immediate threat to life
42 CFR Part 2 permits disclosure without consent in a medical emergency that poses an immediate threat to the patient's life.
Question 5: A patient with opioid use disorder requests that you not document their diagnosis in the medical record to avoid insurance discrimination. What is the most appropriate response?
- Agree to omit the diagnosis to protect the patient from harm
- Explain that accurate documentation is a legal and ethical obligation, but discuss protections available under HIPAA and ADA (Correct answer)
- Transfer care to a provider who agrees to the patient's terms
- Document the diagnosis using only vague language to satisfy both parties
Correct answer: Explain that accurate documentation is a legal and ethical obligation, but discuss protections available under HIPAA and ADA
Accurate documentation is a professional and legal requirement, but the clinician should educate the patient on legal protections against discrimination.
Question 6: Which of the following best describes the concept of 'therapeutic privilege' in addiction medicine?
- The right of patients to choose their own treatment modality
- Withholding information from a patient on the grounds that disclosure would cause significant harm (Correct answer)
- A physician's authority to override a patient's refusal of treatment in emergencies
- Prescribing controlled substances for therapeutic purposes without DEA oversight
Correct answer: Withholding information from a patient on the grounds that disclosure would cause significant harm
Therapeutic privilege allows withholding information when its disclosure would cause serious harm, though it is rarely justified and is largely disfavored in modern ethics.
Question 7: A patient on buprenorphine maintenance tells you they sold some of their medication last month. Ethically and legally, what is the MOST appropriate next step?
- Immediately terminate the patient from your practice
- Document the disclosure, counsel the patient on the seriousness of diversion, reinforce treatment agreements, and increase monitoring (Correct answer)
- Report the patient to law enforcement since diversion is a federal crime
- Ignore the disclosure to preserve the therapeutic alliance
Correct answer: Document the disclosure, counsel the patient on the seriousness of diversion, reinforce treatment agreements, and increase monitoring
Diversion must be addressed directly through counseling, reinforced agreements, and enhanced monitoring while maintaining the therapeutic relationship.
Addiction Medicine Certification Ethics & Professional Standards 2
A patient in your addiction medicine practice discloses that they are a truck driver who has been using opioids without a prescription.
What is the most ethically appropriate initial action?