Legal

Question 1

DATA 2000 - WAIVER is now gone since

Answer 1

Consolidated Appropriations Act of 2023

Question 2

42 CFR Part 2

Answer 2

OTPs/Methadone Clinics have special confidentiality requirements since 1970s and revised in 2020: prohibits unauthorized disclosures of pt records, prohibits use of pt record in criminal prosecution EXCEPT in med emergency, research/quality review, or by court order
*Limited OTP to PDMP information between OTP (clinic) and OBOT (outpt)

Question 3

Medical Malpractice

Answer 3

4Ds = Duty, Derelict/Breach, Direct Cause, Damage

Question 4

4 Core Principles of Ethics

Answer 4

Autonomy, Beneficence, Nonmaleficence, Justice

Question 5

Res Ipsa Loquitur

Answer 5

the thing that speaks for itself = facts - damage - responsibility

Question 6

Respondeat Superior

Answer 6

let the master answer = employer responsible for employees within scope of employment

Question 7

HIPAA

Answer 7

requirement to obtain pt authorization except for tx, payment, required discloures unless - serious contagious disease, CPS, or serious threat

Question 8

EMTALA

Answer 8

screen, stabilize requirement

Question 9

Double Effect Doctrine

Answer 9

It is WRONG to intentionally harm to produce good (cause death as relief from suffering)
It is NOT WRONG to pursue a good result even if the action leads to unintended but foreseen harm (providing morphine to decrease suffering at EOL)

Question 10

Harrison Act

Answer 10

1914, tax on alcohol and tobacco, and made illegal other drugs (heroin, cocaine, hallucinogens incl peyote) so illegal to sell/give made it illegal for doctors giving any as medications and led to a waterfall of repressive drug policies leading to heroin epidemic in 1960s and 2000s

Question 11

Dole & Nyswander

Answer 11

1965 methadone study that use of this drug leads to decreased “narcotic hunger” and life improvement and led to more methadone research and FDA allowance for detox and maintenance

Question 12

FDA approval of methadone for detox

Answer 12

1970

Question 13

FDA approval of methadone for maintenance

Answer 13

1973

Question 14

methadone tx criticisms of 1972 and their effect

Answer 14

criticisms of methadone tx at onset were: access concern to poison children, divergence, and iatrogenic addiction
these criticisms led to increased regulation: max daily dose, counseling req’t, age for tx, and req’t to have OUD x 12months prior to tx

Question 15

Controlled Substances Act

Answer 15

1970 - Scheduled Medications established
limited ability to use RX opioids to tx MOUD

Question 16

Narcotic Addiction Tx Act

Answer 16

1974 - amendment of 1970 original that defined detox and maintenance periods and revoked privileges - WAIVER became the requirement to RX opioids to tx MOUD

Question 17

SAMSHA became oversight for OTPs in USA

Answer 17

2001 - FDA handed this responsibility over to SAMSHA

Question 18

Schedule I - V

Answer 18

I - illegal, no medical use
II - most opiates, cocaine with 90 day max (most states 30 day max)
III - <90mg codeine dose, Tylenol #3, ketamine, anabolic steroids, testosterone
IV - tramadol, soma, zolpidem, BZDs
V - <200mg codeine/100ml robitussin, lyrica, lomotil

Question 19

Schedule I

Answer 19

illegal drugs with no medical use and high risk of misuse

Question 20

Schedule II

Answer 20

II - most opiates, cocaine
ex. hydrocodone, oxycodone, fentanyl, morphine

Question 21

Schedule III

Answer 21

ketamine, Tylenol #3, anabolic steroids, testosterone

Question 22

Schedule IV

Answer 22

tramadol, BZDs. zolpidem, soma

Question 23

Schedule V

Answer 23

<200mg codeine/100ml, robitussin, lyrica, lomotil

Question 24

2016 CDC Guidelines

Answer 24

common opioid-related adverse events, mainly limit BZDs, utilize PDMP, offer or refer for MAT, more caution with methadone
*in 2019 revised to say that “guidelines should not be applied generically and need to be individualized”

Question 25

Benjamin Rush, MD

Answer 25

1784 published Inquiry into the Effects of Ardent Spirits on the Human Mind and Body
established “sober house” and concluded abstinence was only cure since alcohol caused alcoholism and linked intoxication and loss of control

Question 26

The Washingtonians

Answer 26

faith-based change social network with public stories as center of idea, 1840-1855

Question 27

The Salvation Army

Answer 27

1865 to current, largest addiction tx system in the world

Question 28

The Keeley League

Answer 28

1879, 1st franchised, prive, for-profit add tx system, gave toxic medications + non-med tx modalities

Question 29

Prohibition

Answer 29

1919-1933

Question 30

Hazelden and Minnesota Model

Answer 30

Inpatient detox and AA

Question 31

Alan Leshner, PhD

Answer 31

1996 began describing addiction as a brain disease

Question 32

8th Amendment

Answer 32

protection against “cruel and unusual punishment” used for justification for SUD to be tx while in prison/jail

Question 33

14th Amendment

Answer 33

“due process” guarantee for inmates to have care involved in process while incarcerated