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Ethical and Legal Considerations

  • María Luisa MittalEmail author
  • Leo Beletsky
  • Peter J. Davidson
Chapter
  • 65 Downloads

Abstract

In this chapter, the four basic principles of biomedical ethics are discussed in relation to clinical decision-making for patients with SUDs and their families: (1) beneficence, (2) non-maleficence, (3) respect for autonomy and (4) justice. Examples focusing on decisions particular to medication treatment for OUD are presented. Stigma is considered. Additionally, some of the regulatory frameworks that affect substance use are reviewed, including current laws to expand access and availability of naloxone for opioid overdose reversal, the Harrison Narcotics Tax Act of 1914 and the Controlled Substances Act of 1970. The Narcotic Addict Treatment Act of 1974 and the Drug Addiction Treatment Act of 2000 (DATA 2000), under which opioid agonist treatments have been delivered in the United States are explored. Patient confidentiality laws such as 42 CFR Part 2 are also examined.

Keywords

Beneficence Non-maleficence Respect for autonomy Justice Harrison Narcotic Act of 1914 Drug Addiction Treatment Act (DATA) 2000 CFR 42 Part 2 Stigma 

References

  1. 1.
    Beauchamp TL, Childress JF. Principles of biomedical ethics. 7th. ed. New York: Oxford University Press; 2012.Google Scholar
  2. 2.
    Dickens BM, Cook RJ. Law and ethics in conflict over confidentiality? Int J Gynecol Obstet. 2000;70(3):385–91.CrossRefGoogle Scholar
  3. 3.
    D’Aunno T, Park S, Pollack HA. Evidence-based treatment for opioid use disorders: a national study of T methadone dose levels, 2011–2017. J Subst Abuse Treat. 2019;96:18–22.CrossRefGoogle Scholar
  4. 4.
    U.S. Department of Health and Human Services. Medication-assisted treatment for opioid addiction in opioid treatment programs. Treatment Improvement Protocol (TIP) series 43. DHHS publication no. (SMA) 05-4048. Substance Abuse and Mental Health Services Administration: Rockville; 2005.Google Scholar
  5. 5.
    Link BG, Phelan JC. Conceptualizing stigma. Annu Rev Sociol. 2001;27(1):363–85.CrossRefGoogle Scholar
  6. 6.
    American Association for the Treatment of Opioid Dependence (AATOD). Canon of Ethics [Internet]. AATOD. 2019. [cited 2019 May 10]. Available from: http://www.aatod.org/member-center/canon-of-ethics/.
  7. 7.
    Parker R, Aggleton P. HIV and AIDS-related stigma and discrimination: a conceptual framework and implications for action. Soc Sci Med. 2003;57(1):13–24.CrossRefGoogle Scholar
  8. 8.
    Smith LR, Earnshaw VA, Copenhaver MM, Cunningham CO. Substance use stigma: reliability and validity of a theory-based scale for substance-using populations. Drug Alcohol Depend. 2016;162:34–43.CrossRefGoogle Scholar
  9. 9.
    Skinner N, Feather NT, Freeman T, Roche A. Stigma and discrimination in health-care provision to drug users: the role of values, affect, and deservingness judgments. J Appl Soc Psych. 2007;37(1):163–86.CrossRefGoogle Scholar
  10. 10.
    Deering DE, Sheridan J, Sellman JD, Adamson SJ, Pooley S, Robertson R, Henderson C. Consumer and treatment provider perspectives on reducing barriers to opioid substitution treatment and improving treatment attractiveness. Addict Behav. 2011;36(6):636–42.CrossRefGoogle Scholar
  11. 11.
    Lago RR, Peter E, Bógus CM. Harm reduction and tensions in trust and distrust in a mental health service: a qualitative approach. Subst Abuse Treat Prev Policy. 2017;12(1):12.CrossRefGoogle Scholar
  12. 12.
    Ahern J, Stuber J, Galea S. Stigma, discrimination and the health of illicit drug users. Drug Alcohol Depend. 2007;88(2):188–96.CrossRefGoogle Scholar
  13. 13.
    Kulesza M, Larimer ME, Rao D. Substance use related stigma: what we know and the way forward. J Addict Behav Ther Rehabil. 2013;2(2):2–6.CrossRefGoogle Scholar
  14. 14.
    Tran BX, Vu PB, Nguyen LH, et al. Drug addiction stigma in relation to methadone maintenance treatment by different service delivery models in Vietnam. BMC Public Health. 2016;16(1):238.CrossRefGoogle Scholar
  15. 15.
    Luoma JB, Twohig MP, Waltz T, et al. An investigation of stigma in individuals receiving treatment for substance abuse. Addict Behav. 2007;32(7):1331–46.CrossRefGoogle Scholar
  16. 16.
    Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and opioid-involved overdose deaths – United States, 2013–2017. Morb Mortal Wkly Rep. 2019;67(5152):1419–27.Google Scholar
  17. 17.
    U.S. Department of Health and Human Services. HHS acting secretary declares public health emergency to address national opioid crisis. 2017. [cited 2019 May 10]. Available from: https://www.hhs.gov/sites/default/files/opioid%20PHE%20Declaration-no-sig.pdf.
  18. 18.
    Hughes CE, Stevens A. What can we learn from the Portuguese decriminalization of illicit drugs? Br J Criminol. 2010;50(6):999–1022.CrossRefGoogle Scholar
  19. 19.
    National Institute of Law Enforcement and Criminal Justice. The Nation’s toughest drug law: evaluating the New York experience – final report of the Joint Committee on New York Drug Law Evaluation. New York: The Association of the Bar of the City of New York; 1978.Google Scholar
  20. 20.
    Kaeble D, Cowhig M. Correctional populations in the United States, 2016. U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics. 2018; NCJ 251211:1–13. [cited 2019 May 10]. Available from: https://www.bjs.gov/content/pub/pdf/cpus16.pdf.
  21. 21.
    Kaiser Family Foundation. Status of state action on the medicaid expansion decision [Internet]. KFF State Health Facts. 2018. [cited 2019 May 10]. Available from: https://www.kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act.
  22. 22.
    Fiscella K, Beletsky L, Wakeman SE. The inmate exception and reform of correctional health care. Am J Public Health. 2017;107(3):384.CrossRefGoogle Scholar
  23. 23.
    Gostin LO, Hodge JG, Noe SA. Reframing the opioid epidemic as a national emergency. JAMA. 2017;318(16):1539–40.CrossRefGoogle Scholar
  24. 24.
    Network for Public Health Law. Legal interventions to reduce overdose mortality: naloxone access and overdose good Samaritan Laws. Network for Public Health Law (USA); 2018 [cited May 10, 2019]. Available from: https://www.networkforphl.org/_asset/qz5pvn/legal-interventions-to-reduce-overdose.pdf.
  25. 25.
    Harrison Narcotics Tax Act. Public law # 63–223. 1914.Google Scholar
  26. 26.
    Webb v. United States, 249 U.S. 96, 39 S. Ct. 217, 63 L. Ed. 497. 1919.Google Scholar
  27. 27.
    Linder v. United States, 268 U.S. 5, 45 S. Ct. 446, 69 L. Ed. 819. 1925.Google Scholar
  28. 28.
    U.S. Food and Drug Administration. Methadone oral concentrate (methadone hydrochloride oral concentrate USP) and methadone sugar- free oral concentrate (methadone hydrochloride oral concentrate USP) dye-free, sugar-free, unflavored. [cited 2019 May 10]. Available from http://www.accessdata.fda.gov/drugsatfda_docs/label/2008/017116s021lbl.pdf.
  29. 29.
    Opioid Drugs in Maintenance and Detoxification Treatment of Opiate Addiction. Proposed modification of dispensing restrictions for buprenorphine and buprenorphine combination as used in approved opioid treatment medications. 42 C.F.R. § 8.12 (2016) [regulation on the Internet]. [cited 2019 May 10]. Available from: https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=&SID=e3d2eafa3a0991f90e93a038912a687e&mc=true&n=pt42.1.8&r=PART&ty=HTML#sp42.1.8.c.
  30. 30.
    U.S. Department of Health and Human Services. Qualify for a practitioner waiver [Internet]. Substance Abuse and Mental Health Services Administration. 2019. Available from: https://www.samhsa.gov/medication-assisted-treatment/buprenorphine-waiver-management/qualify-for-practitioner-waiver.
  31. 31.
    CSAT (Center for Substance Abuse Treatment). The confidentiality of alcohol and drug abuse patient records regulation and the HIPAA privacy rule: implications for alcohol and substance abuse programs. DHHS publication no. (SMA) 04-3947. Substance Abuse and Mental Health Services Administration: Rockville; 2004. https://www.integration.samhsa.gov/operations-administration/the_confidentiality_of_alcohol_and_drug_abuse.pdf.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • María Luisa Mittal
    • 1
    Email author
  • Leo Beletsky
    • 1
    • 2
  • Peter J. Davidson
    • 1
  1. 1.Department of MedicineUniversity of California San DiegoLa JollaUSA
  2. 2.School of Law & Bouvé College of Health SciencesNortheastern UniversityBostonUSA

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