ADM Ethical, Legal, & Regulatory Considerations in Addiction Medicine 3 — Questions and Answers
Question 1: A state's prescription drug monitoring program (PDMP) report reveals a patient is receiving opioids from three different providers. Which action best reflects both legal and ethical obligations?
- Report all three providers to the state medical board immediately
- Contact the patient for a clinical conversation and coordinate with other prescribers after obtaining consent (Correct answer)
- Refuse to prescribe and discharge the patient immediately
- Ignore the PDMP data since it violates patient privacy
Correct answer: Contact the patient for a clinical conversation and coordinate with other prescribers after obtaining consent
PDMP data should prompt a non-judgmental clinical conversation and care coordination; patient safety is the priority while confidentiality and therapeutic alliance are preserved.
Question 2: Which federal law establishes parity between mental health/substance use disorder benefits and medical/surgical benefits in insurance coverage?
- The Affordable Care Act (ACA)
- The Mental Health Parity and Addiction Equity Act (MHPAEA) (Correct answer)
- The Comprehensive Addiction and Recovery Act (CARA)
- The Drug Abuse Prevention and Control Act
Correct answer: The Mental Health Parity and Addiction Equity Act (MHPAEA)
MHPAEA requires that coverage limitations for mental health and substance use disorder benefits be no more restrictive than those for medical and surgical benefits.
Question 3: A patient with opioid use disorder who is pregnant refuses buprenorphine treatment. The most ethically defensible physician response is to:
- Seek a court order to compel treatment to protect the fetus
- Respect the patient's autonomy, provide comprehensive counseling, and continue to offer treatment (Correct answer)
- Contact child protective services immediately
- Refer only to residential treatment and decline outpatient care
Correct answer: Respect the patient's autonomy, provide comprehensive counseling, and continue to offer treatment
Patient autonomy must be respected; the physician should provide thorough counseling about risks, document the discussion, and keep the therapeutic relationship open for future engagement.
Question 4: The DATA 2000 (Drug Addiction Treatment Act) was historically significant in addiction medicine because it:
- Created mandatory minimum sentences for opioid trafficking
- Allowed qualified physicians to prescribe Schedule III-V narcotic medications for opioid use disorder in office-based settings (Correct answer)
- Established methadone maintenance as a federally recognized treatment
- Required all states to implement PDMPs
Correct answer: Allowed qualified physicians to prescribe Schedule III-V narcotic medications for opioid use disorder in office-based settings
DATA 2000 allowed DEA-waivered physicians to prescribe buprenorphine (Schedule III) for opioid use disorder treatment outside of opioid treatment programs for the first time.
Question 5: Which of the following scenarios most clearly represents a conflict of interest in addiction medicine practice?
- A physician accepting a speaking fee from a pharmaceutical company that manufactures a drug the physician prescribes
- A physician asking a recovering patient to assist with office administrative tasks
- A physician treating their own family member for alcohol use disorder
- All of the above (Correct answer)
Correct answer: All of the above
All three scenarios involve relationships or incentives that could impair clinical objectivity and professional judgment, constituting conflicts of interest.
Question 6: Under what circumstances may a substance use disorder treatment program disclose patient information to law enforcement without patient consent under 42 CFR Part 2?
- When a patient commits a crime on program premises or against program personnel (Correct answer)
- When law enforcement presents a valid subpoena
- When the patient is suspected of drug trafficking
- When requested by a federal prosecutor
Correct answer: When a patient commits a crime on program premises or against program personnel
42 CFR Part 2 permits disclosure to law enforcement only when the crime is committed on program premises or against program personnel, without requiring patient consent.
Question 7: A physician prescribing buprenorphine is ethically obligated to establish and maintain which of the following with each patient?
- A urine drug screen schedule approved by the DEA
- A therapeutic alliance with clear treatment goals, informed consent, and ongoing monitoring (Correct answer)
- A written contract that terminates treatment upon any positive drug screen
- Mandatory attendance at 12-step meetings as a condition of prescription renewal
Correct answer: A therapeutic alliance with clear treatment goals, informed consent, and ongoing monitoring
Ethical MOUD practice centers on therapeutic alliance, individualized treatment goals, informed consent, and evidence-based monitoring rather than punitive contingencies.
ADM Ethical, Legal, & Regulatory Considerations in Addiction Medicine 3
A state's prescription drug monitoring program (PDMP) report reveals a patient is receiving opioids from three different providers.
Which action best reflects both legal and ethical obligations?