Addiction Medicine Certification Patient Safety & Risk Management 2 — Questions and Answers
Question 1: A patient on buprenorphine/naloxone reports taking extra doses 'just in case.' Which action best addresses this medication misuse risk?
- Discontinue buprenorphine immediately
- Implement a pill count protocol and re-educate on prescribed dosing (Correct answer)
- Switch to methadone maintenance without counseling
- Report the patient to law enforcement
Correct answer: Implement a pill count protocol and re-educate on prescribed dosing
Pill counts combined with patient education address misuse patterns without abruptly removing effective treatment.
Question 2: Which PDMP (Prescription Drug Monitoring Program) practice is considered a key safety intervention for patients receiving controlled substances for addiction?
- Checking PDMP only at initial visit
- Checking PDMP at every controlled substance prescription (Correct answer)
- Using PDMP only when law enforcement requests it
- Checking PDMP quarterly regardless of visit frequency
Correct answer: Checking PDMP at every controlled substance prescription
Checking the PDMP at every controlled substance prescription identifies concurrent prescriptions and reduces diversion risk.
Question 3: A patient with opioid use disorder and untreated depression presents for MOUD. What is the safest approach?
- Delay MOUD until depression resolves
- Initiate MOUD while simultaneously addressing depression treatment (Correct answer)
- Prescribe antidepressants only and defer MOUD
- Refer to psychiatry and discharge from addiction care
Correct answer: Initiate MOUD while simultaneously addressing depression treatment
Co-occurring disorders should be treated concurrently; delaying MOUD increases overdose risk.
Question 4: Which patient factor most significantly increases overdose risk during opioid use disorder treatment?
- Having a stable housing situation
- Recent period of abstinence reducing opioid tolerance (Correct answer)
- Being enrolled in a 12-step program
- Having regular primary care visits
Correct answer: Recent period of abstinence reducing opioid tolerance
Tolerance drops rapidly during abstinence, so returning to prior use doses can be lethal.
Question 5: A buprenorphine-treated patient plans elective surgery requiring general anesthesia. What is the safest perioperative recommendation?
- Stop buprenorphine 72 hours before surgery without alternative
- Coordinate with the anesthesiologist; generally continue buprenorphine to prevent withdrawal and relapse (Correct answer)
- Switch to full agonist opioids one week pre-operatively without informing the surgeon
- Administer naloxone preoperatively to clear buprenorphine
Correct answer: Coordinate with the anesthesiologist; generally continue buprenorphine to prevent withdrawal and relapse
Current guidelines favor continuing buprenorphine perioperatively with anesthesia team communication to manage pain safely.
Question 6: Which informed consent element is most critical before initiating naltrexone extended-release injection for alcohol use disorder?
- Patient's willingness to attend AA meetings
- Disclosure of increased opioid sensitivity and overdose risk if opioids are used after naltrexone wears off (Correct answer)
- Guarantee that naltrexone prevents all cravings
- Agreement to avoid all over-the-counter medications
Correct answer: Disclosure of increased opioid sensitivity and overdose risk if opioids are used after naltrexone wears off
Naltrexone blocks opioid receptors; after the medication wears off, opioid sensitivity increases, raising overdose risk if opioids are used.
Question 7: A patient in methadone maintenance requires hospitalization and the hospital staff are unaware of the dose. What is the safest action?
- Withhold all opioids until the OTP is contacted
- Contact the OTP immediately to verify dose and continue methadone to prevent withdrawal (Correct answer)
- Estimate the dose based on the patient's report without verification
- Switch to oral morphine at an equivalent dose without OTP input
Correct answer: Contact the OTP immediately to verify dose and continue methadone to prevent withdrawal
OTP verification ensures accurate dosing continuity and prevents both withdrawal and inadvertent overdose.
Addiction Medicine Certification Patient Safety & Risk Management 2
A patient on buprenorphine/naloxone reports taking extra doses 'just in case.' Which action best addresses this medication misuse risk?