ADM Ethical, Legal, & Regulatory Considerations in Addiction Medicine 2 — Questions and Answers
Question 1: Under 42 CFR Part 2, which of the following actions requires patient consent even when a subpoena has been issued?
- Releasing records to law enforcement
- Releasing records to the patient's primary care physician
- Disclosing records to a court without a court order (Correct answer)
- Disclosing records for Medicare billing audits
Correct answer: Disclosing records to a court without a court order
42 CFR Part 2 prohibits disclosure of substance use disorder records in response to a subpoena alone — a court order meeting specific criteria is required, and even then patient notice is mandated.
Question 2: A physician treating a patient for opioid use disorder in an office-based setting discovers the patient is also receiving buprenorphine from another provider. The most ethically appropriate immediate step is to:
- Report the patient to the DEA immediately
- Discharge the patient for non-compliance
- Discuss the situation with the patient to clarify treatment history and coordinate care (Correct answer)
- Contact the other provider without the patient's consent
Correct answer: Discuss the situation with the patient to clarify treatment history and coordinate care
Ethical practice requires direct, non-punitive patient communication to understand the clinical context before taking action, consistent with principles of beneficence and non-abandonment.
Question 3: The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 primarily restricts which of the following?
- Prescribing controlled substances via telemedicine without a prior in-person evaluation (Correct answer)
- Over-the-counter sale of pseudoephedrine
- Off-label prescribing of buprenorphine
- Dispensing methadone outside of OTPs
Correct answer: Prescribing controlled substances via telemedicine without a prior in-person evaluation
The Ryan Haight Act generally requires at least one in-person medical evaluation before a practitioner may prescribe controlled substances via telemedicine.
Question 4: Which ethical principle is most directly violated when a physician withholds effective addiction treatment from a patient due to personal moral objections to the patient's lifestyle?
- Autonomy
- Justice (Correct answer)
- Non-maleficence
- Veracity
Correct answer: Justice
Justice requires fair and equitable treatment of all patients; withholding evidence-based care based on personal bias constitutes an unjust act.
Question 5: A patient in a medication-assisted treatment program discloses during a session that they plan to drive a heavy commercial truck while taking methadone. The physician's ethical obligation includes:
- Immediate mandatory reporting to the Department of Transportation
- Warning the patient of the risks and documenting the discussion; report only if imminent threat to an identifiable third party exists under applicable law (Correct answer)
- Discontinuing methadone to eliminate the safety risk
- Obtaining consent to notify the patient's employer
Correct answer: Warning the patient of the risks and documenting the discussion; report only if imminent threat to an identifiable third party exists under applicable law
The Tarasoff duty-to-warn applies to identifiable third parties facing imminent harm; the physician must counsel the patient, document it, and evaluate whether reportable risk exists under state law.
Question 6: Under the Americans with Disabilities Act (ADA), which of the following individuals with a substance use history is MOST likely protected?
- A person currently using illegal drugs
- A person in recovery from alcohol use disorder who no longer drinks (Correct answer)
- A person currently engaging in the illegal sale of controlled substances
- A person arrested for DUI last week
Correct answer: A person in recovery from alcohol use disorder who no longer drinks
The ADA protects individuals who are in recovery from alcohol or drug use disorder, but current illegal drug use is explicitly excluded from ADA protection.
Question 7: Which of the following best describes the concept of 'informed consent' as it applies to initiating buprenorphine-naloxone therapy?
- Patient must sign a controlled substance agreement before any discussion of treatment options
- Clinician must explain risks, benefits, alternatives, and obtain voluntary agreement from a competent patient (Correct answer)
- Informed consent is waived in emergency addiction treatment situations
- Only written consent is legally valid; verbal consent is insufficient
Correct answer: Clinician must explain risks, benefits, alternatives, and obtain voluntary agreement from a competent patient
Informed consent requires disclosure of material information about risks, benefits, and alternatives, with voluntary agreement from a decisionally capable patient.
ADM Ethical, Legal, & Regulatory Considerations in Addiction Medicine 2
Under 42 CFR Part 2, which of the following actions requires patient consent even when a subpoena has been issued?