Innovations In Clinical Neuroscience

MAY-JUN 2017

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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Innovations in CLINICAL NEUROSCIENCE [ V O L U M E 1 4 , N U M B E R 5 – 6 , M A Y – J U N E 2 0 1 7 ] 25 ABSTRACT Patients receiving end-of-life or palliative care usually possess an ample supply of pain medications to help alleviate their pain. The risk of these drugs being diverted is high because such patients often have an excess of these medications, and because they are typically unable to manage medications themselves. For example, adolescents might steal these medications for recreational use. The author presents a case in which a minor admitted stealing and using opioid pain medication belonging to her mother, who was in hospice home care. Using the minor's right of confidentiality, she clearly instructed the treatment team not to contact her family about her substance use. This caused a significant professional and ethical dilemma, forcing the team to consider the minor's rights of confidentiality in addition to safety. INTRODUCTION Substance use co-morbid with depression is a relatively common presentation among adolescents in the clinical setting. 1 In 2014, an estimated 1.3 million youths (12–17 years of age) in the United States had a substance use disorder. About 0.7 percent of the adolescent population had an opioid use disorder. An estimated 1.4 percent of adolescents met the criteria for both major depressive disorder and substance use disorder. 2 Treatment rates for substance use among adolescents have remained stable and low for the past 22 years, despite a tremendous increase in the evidence of the effectiveness of new treatments. 3 To provide easier access to healthcare, many state statutes are written to allow minors to give their own consent to treatment for mental health and alcohol and substance use treatment disorders without parental consent. This allows motivated adolescents to seek treatment independently without risking the potentially negative consequences resulting from parents' knowledge about their substance use. In practice, only a small number (16.5%) of all drug treatments for youth are made after self- referrals compared to nearly half (46.5%) resulting from court-mandated treatment orders. 4 Minors can legally prevent physicians from sharing medical information with their families. 5 This principle can lead to a professional and legal dilemma for physicians who have to decide between a patient's right of confidentiality and the safety of an adolescent who is stealing controlled medications and abusing them. Parents have access to a minor's medical records. When treating minors for substance use without informing the parents or guardians, clinicians risk the possibility that the parents/guardians will terminate treatment once they discover their child has been in treatment without their knowledge or consent. CASE REPORT M, a 15-year-old girl, presented at the clinic for treatment of behavioral problems in school and for depression. She was diagnosed with attention deficit hyperactivity disorder (ADHD) and major depressive disorder. She was admitted to an intensive outpatient level of care. She expressed chronic, passive, and by MUHAMMAD HASSAN MAJEED, MD Dr. Majeed is an Attending Psychiatrist at Natchaug Hospital, Norwich, Connecticut. Innov Clin Neurosci. 2017;14(5–6):25–27 FUNDING: No funding was received for the preparation of this article. FINANCIAL DISCLOSURES: The author has no conflicts of interest relevant to the content of this article. ADDRESS CORRESPONDENCE TO: Muhammad Hassan Majeed, MD, Attending Psychiatrist, Natchaug Hospital, 11A Stott Avenue, Norwich, CT 06360; Phone: 917-833-4407; Fax: 860-886- 6567; email: Hassan.Mjaeed@Icloud.com KEY WORDS: Opioids, diversion, safety, confidentiality, adolescents C A S E R E P O R T WHEN THE OPIOID MEDICATIONS Go Missing: Confidentiality and Safety in Adolescents

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