Addiction Medicine Certification Treatment Planning & Protocols 3 — Questions and Answers
Question 1: A patient stabilized on methadone maintenance wants to transition to buprenorphine. What is the primary clinical concern during this transition?
- Risk of serotonin syndrome due to drug-drug interactions
- Risk of precipitated withdrawal because buprenorphine is a partial agonist displacing methadone (Correct answer)
- Requirement for a 30-day washout period before buprenorphine can be started
- Buprenorphine is contraindicated in patients who have ever used methadone
Correct answer: Risk of precipitated withdrawal because buprenorphine is a partial agonist displacing methadone
Buprenorphine's high mu-receptor affinity and partial agonism can displace methadone and precipitate acute withdrawal if started too soon.
Question 2: Which of the following is a core component of a recovery-oriented system of care (ROSC)?
- Limiting patient contact to the acute stabilization phase only
- Providing a fixed, time-limited treatment episode
- Coordinating long-term supports including peer recovery, housing, and employment (Correct answer)
- Prioritizing abstinence-only approaches and excluding medication-assisted treatment
Correct answer: Coordinating long-term supports including peer recovery, housing, and employment
ROSC emphasizes sustained, coordinated community-based supports — including peer services, housing, and employment — beyond acute treatment.
Question 3: When developing a treatment plan for a patient with co-occurring PTSD and alcohol use disorder, which integrated approach is supported by evidence?
- Treat PTSD only after achieving 12 months of sobriety
- Treat alcohol use disorder first, then sequentially address PTSD
- Use simultaneous, integrated treatment addressing both disorders concurrently (Correct answer)
- Refer PTSD exclusively to mental health providers with no addiction medicine involvement
Correct answer: Use simultaneous, integrated treatment addressing both disorders concurrently
Integrated concurrent treatment of co-occurring PTSD and AUD (e.g., Seeking Safety, CPT with naltrexone) produces better outcomes than sequential approaches.
Question 4: A physician wants to prescribe buprenorphine/naloxone for OUD in an office-based setting in the US. What is required as of current federal regulations (post-2023 MATE Act)?
- Complete an 8-hour waiver training and register separately with SAMHSA
- Hold a valid DEA Schedule III registration with no additional OUD-specific waiver required (Correct answer)
- Obtain a separate X-waiver and limit initial practice to 30 patients
- Be board-certified in addiction medicine or addiction psychiatry
Correct answer: Hold a valid DEA Schedule III registration with no additional OUD-specific waiver required
The 2023 Consolidated Appropriations Act eliminated the X-waiver requirement; prescribers with a standard DEA Schedule III license may now prescribe buprenorphine for OUD.
Question 5: Which pharmacotherapy is FDA-approved specifically for reducing heavy drinking days in alcohol use disorder?
- Disulfiram
- Acamprosate
- Naltrexone (Correct answer)
- Topiramate
Correct answer: Naltrexone
Naltrexone (oral and XR injectable) is FDA-approved for AUD and has robust evidence for reducing heavy drinking days by blocking opioid-mediated reward.
Question 6: A patient with stimulant use disorder is interested in pharmacotherapy. Which statement about medication options is most accurate?
- Bupropion and mirtazapine show modest evidence for methamphetamine use disorder (Correct answer)
- Naltrexone is FDA-approved for stimulant use disorder
- Methadone is an effective maintenance therapy for cocaine use disorder
- No pharmacotherapy has shown any benefit for stimulant use disorders in clinical trials
Correct answer: Bupropion and mirtazapine show modest evidence for methamphetamine use disorder
Bupropion plus naltrexone and mirtazapine have shown modest efficacy for methamphetamine use disorder; no agent is FDA-approved yet.
Question 7: In relapse prevention planning, which cognitive-behavioral skill is specifically designed to address high-risk situations for substance use?
- Behavioral activation scheduling
- Urge surfing and cue exposure with response prevention (Correct answer)
- Systematic desensitization for phobia
- Thought stopping for obsessive-compulsive patterns
Correct answer: Urge surfing and cue exposure with response prevention
Urge surfing teaches patients to ride out cravings without acting on them; cue exposure therapy reduces conditioned responses to use-related triggers.
Addiction Medicine Certification Treatment Planning & Protocols 3
A patient stabilized on methadone maintenance wants to transition to buprenorphine.
What is the primary clinical concern during this transition?