Addiction Medicine Certification Patient Safety & Risk Management 3 — Questions and Answers
Question 1: Which tool is validated for assessing aberrant drug-related behaviors in patients receiving opioids for pain or addiction?
- GAD-7
- Current Opioid Misuse Measure (COMM) (Correct answer)
- CAGE questionnaire
- Columbia Suicide Severity Rating Scale
Correct answer: Current Opioid Misuse Measure (COMM)
The COMM is specifically validated to detect aberrant drug-related behaviors in patients on chronic opioid therapy.
Question 2: A pregnant patient with OUD refuses buprenorphine and requests rapid detoxification. What is the safest response?
- Respect autonomy and proceed with rapid detox
- Counsel that rapid detox is contraindicated in pregnancy due to fetal distress risk; strongly recommend MOUD (Correct answer)
- Offer naltrexone as a safe alternative during pregnancy
- Discharge the patient for non-compliance
Correct answer: Counsel that rapid detox is contraindicated in pregnancy due to fetal distress risk; strongly recommend MOUD
Medically supervised withdrawal in pregnancy carries high fetal risk; MOUD (methadone or buprenorphine) is the evidence-based standard of care.
Question 3: What is the purpose of an urine drug screen (UDS) in the context of addiction medicine patient safety?
- To punish patients who use substances
- To monitor treatment adherence, detect polysubstance use, and guide clinical decision-making (Correct answer)
- To provide evidence for legal action against patients
- To satisfy insurance requirements only
Correct answer: To monitor treatment adherence, detect polysubstance use, and guide clinical decision-making
UDS is a clinical safety tool to confirm medication adherence, detect unreported substance use, and personalize treatment.
Question 4: A patient taking methadone is prescribed azithromycin for an infection. What safety concern must be addressed?
- Azithromycin accelerates methadone metabolism, causing withdrawal
- Both azithromycin and methadone prolong the QTc interval, increasing arrhythmia risk (Correct answer)
- Azithromycin blocks methadone absorption in the gut
- This combination causes serotonin syndrome
Correct answer: Both azithromycin and methadone prolong the QTc interval, increasing arrhythmia risk
Both agents prolong the QTc interval; concurrent use can cause dangerous arrhythmias including torsades de pointes.
Question 5: Which scenario represents an appropriate use of a treatment contract in addiction medicine?
- As a punitive tool to justify discharge after any positive UDS
- To outline mutual expectations, patient responsibilities, and consequences within a therapeutic framework (Correct answer)
- To legally bind the patient to abstinence from all substances
- To replace informed consent for controlled substance prescribing
Correct answer: To outline mutual expectations, patient responsibilities, and consequences within a therapeutic framework
Treatment contracts clarify expectations and responsibilities collaboratively, supporting engagement rather than serving as punitive instruments.
Question 6: A patient with stimulant use disorder reports chest pain and palpitations. What is the most appropriate immediate action?
- Reassure the patient that stimulant use commonly causes minor chest pain
- Evaluate urgently for cardiac complications including arrhythmia, myocardial infarction, or aortic dissection (Correct answer)
- Prescribe a benzodiazepine and observe in the clinic
- Schedule a cardiology referral for next month
Correct answer: Evaluate urgently for cardiac complications including arrhythmia, myocardial infarction, or aortic dissection
Stimulant intoxication can cause life-threatening cardiac events requiring immediate evaluation.
Question 7: What is the primary safety rationale for dispensing naloxone to all patients receiving opioid agonist therapy?
- To allow patients to reverse their own MOUD doses
- To provide a rescue option in case of accidental opioid overdose involving illicitly obtained opioids (Correct answer)
- To test whether patients are adherent to their MOUD
- To comply with federal regulations for methadone clinics only
Correct answer: To provide a rescue option in case of accidental opioid overdose involving illicitly obtained opioids
Even patients on MOUD can encounter illicitly obtained opioids; naloxone access reduces fatal overdose risk.
Addiction Medicine Certification Patient Safety & Risk Management 3
Which tool is validated for assessing aberrant drug-related behaviors in patients receiving opioids for pain or addiction?