MCQ Quiz: Legal & Ethical Issues – Substance Abuse

The pharmacist’s role in the substance abuse crisis is a complex balancing act, poised at the intersection of compassionate patient care, public health, and stringent legal obligations. Navigating this landscape requires more than clinical knowledge; it demands a sophisticated understanding of federal and state law, a firm grasp of ethical principles, and the professional judgment to act in the best interest of both the individual patient and the community. As detailed in the Patient Care and Pharmacy Law curricula, pharmacists must be adept at identifying red flags, exercising their corresponding responsibility, and applying ethical frameworks like beneficence and non-maleficence. This quiz will test your knowledge of the critical legal and ethical issues surrounding substance abuse management.

1. The legal principle that holds both the prescriber and the pharmacist jointly responsible for the legitimacy of a controlled substance prescription is known as:

• a) The Principle of Double Effect
• b) Corresponding Responsibility
• c) Strict Liability
• d) Respondeat Superior Answer: b) Corresponding Responsibility

2. As discussed in the Patient Care VII curriculum, a pharmacist who identifies several “red flags” for a controlled substance prescription has an ethical and legal duty to:

• a) Fill the prescription immediately to avoid conflict.
• b) Take steps to ensure the prescription is for a legitimate medical purpose before dispensing.
• c) Tell the patient to go to another pharmacy.
• d) Report the patient to the local news. Answer: b) Take steps to ensure the prescription is for a legitimate medical purpose before dispensing.

3. Which of the following scenarios would be considered a “red flag” for potential prescription drug misuse or diversion?

• a) A patient receiving a 90-day supply of lisinopril for hypertension.
• b) A new patient who has traveled an unusual distance and offers to pay cash for a large quantity of oxycodone.
• c) A patient requesting a refill for their albuterol inhaler.
• d) A long-time patient asking for counseling on a new medication. Answer: b) A new patient who has traveled an unusual distance and offers to pay cash for a large quantity of oxycodone.

4. The ethical principle of “non-maleficence” (do no harm) best supports which pharmacist action?

• a) Providing a patient with any medication they request.
• b) Refusing to fill a prescription that the pharmacist believes is fraudulent or will harm the patient.
• c) Selling the most expensive product to increase pharmacy profits.
• d) Sharing the patient’s private information with their employer. Answer: b) Refusing to fill a prescription that the pharmacist believes is fraudulent or will harm the patient.

5. Under the federal Controlled Substances Act, a prescription for a Schedule II medication like hydromorphone must generally be:

• a) Dispensed with up to 5 refills in 6 months.
• b) Phoned in by the prescriber in all situations.
• c) Written or sent electronically, with very limited exceptions for oral orders in an emergency.
• d) Valid for one year from the date written. Answer: c) Written or sent electronically, with very limited exceptions for oral orders in an emergency.

6. The Professionals Resource Network (PRN) in Florida is a program designed to:

• a) Discipline and revoke the licenses of impaired practitioners.
• b) Help impaired healthcare practitioners (including pharmacists) receive confidential help and monitoring for SUDs.
• c) Provide legal defense for pharmacists accused of malpractice.
• d) Set the reimbursement rates for SUD treatment. Answer: b) Help impaired healthcare practitioners (including pharmacists) receive confidential help and monitoring for SUDs.

7. Under HIPAA, a pharmacist is permitted to share a patient’s prescription information without their explicit authorization with:

• a) The patient’s employer for a background check.
• b) A journalist writing a story on the opioid crisis.
• c) The prescribing physician to coordinate the patient’s care.
• d) A pharmaceutical sales representative. Answer: c) The prescribing physician to coordinate the patient’s care.

8. Pharmacists in many states, including Florida, are able to dispense naloxone to patients or caregivers under a ________, which is a key harm reduction strategy.

• a) Patient-specific prescription
• b) DEA Form 222
• c) Standing order
• d) Therapeutic interchange protocol Answer: c) Standing order

9. The ethical principle of “beneficence” (the duty to do good) would support a pharmacist proactively:

• a) Refusing to counsel any patients on their medications.
• b) Identifying patients at risk for opioid overdose and recommending naloxone co-prescribing.
• c) Criticizing a patient’s lifestyle choices.
• d) Hiding information about medication side effects from a patient. Answer: b) Identifying patients at risk for opioid overdose and recommending naloxone co-prescribing.

10. What is a pharmacist’s legal and ethical obligation upon discovering a fellow pharmacist colleague may be impaired and diverting controlled substances at work?

• a) To ignore the situation to avoid confrontation.
• b) To report the colleague to a supervisor and/or the state Board of Pharmacy.
• c) To help the colleague cover up their actions.
• d) To post about the situation on social media. Answer: b) To report the colleague to a supervisor and/or the state Board of Pharmacy.

11. Federal law requires pharmacies to keep records of controlled substance dispensing for how long?

• a) 6 months
• b) 1 year
• c) At least 2 years
• d) For the lifetime of the patient Answer: c) At least 2 years

12. The use of a state’s Prescription Drug Monitoring Program (PDMP), like E-FORCSE in Florida, helps a pharmacist identify:

• a) A patient’s allergies.
• b) A patient’s insurance information.
• c) Potential “doctor shopping” or overlapping controlled substance prescriptions.
• d) The patient’s preferred pharmacy. Answer: c) Potential “doctor shopping” or overlapping controlled substance prescriptions.

13. A patient is prescribed methadone for Opioid Use Disorder (OUD). From a legal standpoint, where must this prescription typically be filled?

• a) It can be filled at any community pharmacy.
• b) It can only be filled at a hospital pharmacy.
• c) It must be dispensed directly from a licensed Opioid Treatment Program (OTP).
• d) The patient can pick it up from the prescriber’s office. Answer: c) It must be dispensed directly from a licensed Opioid Treatment Program (OTP).

14. A patient’s right to make their own healthcare decisions, such as refusing a recommended treatment for SUD, is based on the ethical principle of:

• a) Justice
• b) Fidelity
• c) Non-maleficence
• d) Autonomy Answer: d) Autonomy

15. Florida Statute 465.015, “Violations and Penalties,” outlines the legal consequences for pharmacists who:

• a) Counsel a patient for too long.
• b) Fail to comply with pharmacy laws and regulations.
• c) Offer a patient a brand-name drug when a generic is available.
• d) Work more than 40 hours a week. Answer: b) Fail to comply with pharmacy laws and regulations.

16. A pharmacist who knowingly fills a forged prescription for a controlled substance could face:

• a) A commendation from the DEA.
• b) Civil and criminal penalties, and action against their license.
• c) A mandatory salary increase.
• d) No consequences, as only the forger is responsible. Answer: b) Civil and criminal penalties, and action against their license.

17. The act of stigmatizing a patient with an SUD is an ethical failure that can lead to:

• a) Better treatment adherence.
• b) The patient being unwilling to seek or continue care.
• c) Improved patient-pharmacist relationships.
• d) A cure for their disorder. Answer: b) The patient being unwilling to seek or continue care.

18. According to the Principles of Pharmacy Law & Ethics course, ordering Schedule II controlled substances can be done electronically through which system?

• a) The pharmacy’s regular wholesaler website
• b) The Controlled Substance Ordering System (CSOS)
• c) Emailing the manufacturer directly
• d) Faxing a handwritten form to the DEA Answer: b) The Controlled Substance Ordering System (CSOS)

19. A situation where a pharmacist must choose between two or more conflicting ethical duties (e.g., patient autonomy vs. non-maleficence) is known as:

• a) A red flag
• b) A clinical error
• c) An ethical dilemma
• d) Malpractice Answer: c) An ethical dilemma

20. It is ethically and legally problematic for a pharmacist to enter into a financial arrangement with a prescriber where the pharmacist pays the prescriber for every controlled substance prescription sent to their pharmacy. This is known as a:

• a) A kickback
• b) A standing order
• c) A collaborative practice agreement
• d) A formulary decision Answer: a) A kickback

21. In an emergency situation, a prescriber may phone in a prescription for a Schedule II medication, but the pharmacist must receive a written or electronic prescription within what timeframe?

• a) 24 hours
• b) 48 hours
• c) 7 days
• d) 30 days Answer: c) 7 days

22. When counseling a patient on naloxone, what is an important ethical consideration?

• a) To use judgmental language about the patient’s substance use.
• b) To provide the counseling in a private area to respect patient confidentiality.
• c) To only provide counseling if the patient pays an extra fee.
• d) To refuse to counsel the patient’s family members on how to use it. Answer: b) To provide the counseling in a private area to respect patient confidentiality.

23. Under federal law, what is the maximum number of times a prescription for a Schedule III or IV medication (e.g., benzodiazepines) can be refilled?

• a) Once
• b) Up to 5 times within 6 months
• c) Up to 11 times within 12 months
• d) Indefinitely Answer: b) Up to 5 times within 6 months

24. The ethical principle of Justice, in the context of SUDs, would support:

• a) Providing treatment only to wealthy patients.
• b) Advocating for equitable access to SUD treatment for all individuals, regardless of their socioeconomic status.
• c) Denying naloxone to patients without insurance.
• d) Allowing physicians to only treat a certain type of patient. Answer: b) Advocating for equitable access to SUD treatment for all individuals, regardless of their socioeconomic status.

25. A pharmacist receives a prescription for buprenorphine/naloxone. What must be on the prescription besides the standard requirements?

• a) The patient’s employer information.
• b) The prescriber’s unique DEA number that starts with “X”.
• c) The pharmacy’s license number.
• d) The patient’s signature. Answer: b) The prescriber’s unique DEA number that starts with “X”.

26. If a pharmacist has a moral or ethical objection to dispensing a medication for SUD, what is their professional responsibility?

• a) To lecture the patient on their life choices.
• b) To ensure the patient has access to the medication through another pharmacist or pharmacy in a timely manner.
• c) To confiscate the prescription and refuse to return it.
• d) To close the pharmacy for the day. Answer: b) To ensure the patient has access to the medication through another pharmacist or pharmacy in a timely manner.

27. The Combat Methamphetamine Epidemic Act of 2005 is a federal law that regulates the sale of which OTC product?

• a) Dextromethorphan
• b) Loperamide
• c) Pseudoephedrine
• d) Diphenhydramine Answer: c) Pseudoephedrine

28. A pharmacist who fails to check the PDMP before dispensing an opioid, in a state where it is mandatory, has committed a:

• a) Legal violation
• b) Minor paperwork error
• c) Recommended but optional action
• d) Patient-approved shortcut Answer: a) Legal violation

29. The ethical framework that focuses on the consequences of an action to determine if it is right or wrong is called:

• a) Deontology
• b) Utilitarianism
• c) Virtue ethics
• d) Autonomy Answer: b) Utilitarianism

30. Which of the following is NOT a legally required element on a prescription for a controlled substance?

• a) Patient’s full name and address
• b) Prescriber’s signature
• c) Patient’s occupation
• d) Drug name, strength, and dosage form Answer: c) Patient’s occupation

31. The legal concept of “pharmacist malpractice” requires a plaintiff to prove duty, breach of duty, causation, and:

• a) Intent
• b) Damages
• c) A verbal apology
• d) A “red flag” Answer: b) Damages

32. Dispensing a controlled substance prescription that a reasonable pharmacist would have recognized as not being for a legitimate medical purpose could lead to accusations of:

• a) Excellent customer service
• b) Violating the principle of corresponding responsibility
• c) Good clinical judgment
• d) Following the prescriber’s orders without question Answer: b) Violating the principle of corresponding responsibility

33. The ethical duty to be truthful and not deceive patients is known as:

• a) Veracity
• b) Fidelity
• c) Justice
• d) Paternalism Answer: a) Veracity

34. In Florida, a pharmacist has a legal right to refuse to fill a prescription if they believe it is not in the best interest of the patient. This right is an exercise of:

• a) Their corresponding responsibility and professional judgment.
• b) A desire to be difficult.
• c) The patient’s autonomy.
• d) A corporate policy. Answer: a) Their corresponding responsibility and professional judgment.

35. A “take-back” day or permanent drug disposal bin in a pharmacy is a legal and ethical response to:

• a) The need to safely dispose of unused medications, especially controlled substances, to prevent diversion.
• b) A shortage of medications in the pharmacy.
• c) The need to restock the pharmacy shelves.
• d) A marketing campaign. Answer: a) The need to safely dispose of unused medications, especially controlled substances, to prevent diversion.

36. A key legal issue in the management of substance use is ensuring that policies and procedures:

• a) Make it as difficult as possible for patients to receive care.
• b) Comply with both federal and state laws, which may differ.
• c) Are based on the pharmacist’s personal opinions.
• d) Are never written down. Answer: b) Comply with both federal and state laws, which may differ.

37. From an ethical standpoint, using a urine drug test to guide a therapeutic conversation is supported, while using it to ________ is discouraged.

• a) Monitor adherence
• b) Punish and shame a patient
• c) Detect other risky substance use
• d) Build trust Answer: b) Punish and shame a patient

38. The partial filling of a Schedule II prescription is legally permissible if:

• a) The patient requests it or the pharmacy is out of stock.
• b) The patient does not have insurance.
• c) The prescriber is on vacation.
• d) Never, all C-IIs must be filled in full. Answer: a) The patient requests it or the pharmacy is out of stock.

39. Ethical patient care for SUDs involves treating the disorder with the same level of care and professionalism as:

• a) A minor inconvenience.
• b) Other chronic diseases like diabetes or hypertension.
• c) A condition that does not require medical intervention.
• d) A moral failing. Answer: b) Other chronic diseases like diabetes or hypertension.

40. A pharmacist’s participation in an “Opioid activity” IPE is designed to improve:

• a) Dispensing speed.
• b) Understanding of team members’ roles and reduce interprofessional conflict.
• c) Inventory management.
• d) Marketing skills. Answer: b) Understanding of team members’ roles and reduce interprofessional conflict.

41. The legal requirement for counterfeit-proof prescription pads for certain controlled substances in Florida is designed to:

• a) Make prescriptions more expensive.
• b) Prevent prescription forgery and fraud.
• c) Increase the workload for prescribers.
• d) Ensure all prescriptions are legible. Answer: b) Prevent prescription forgery and fraud.

42. The ethical principle of “fidelity” requires a pharmacist to:

• a) Be faithful to their duties and obligations to the patient.
• b) Always agree with the physician.
• c) Prioritize profit over patient care.
• d) Work as quickly as possible. Answer: a) Be faithful to their duties and obligations to the patient.

43. A pharmacist providing a false or misleading answer to a patient’s question about their SUD medication would be violating the ethical principle of:

• a) Justice
• b) Autonomy
• c) Veracity
• d) Beneficence Answer: c) Veracity

44. Which of the following is an ethical challenge in using a PDMP?

• a) The data is always 100% accurate and up-to-date.
• b) Interpreting the data without bias and avoiding making assumptions about the patient’s intentions.
• c) The system is too easy to use.
• d) The system violates no patient privacy rights. Answer: b) Interpreting the data without bias and avoiding making assumptions about the patient’s intentions.

45. Legally, a pharmacist can add or change what information on a Schedule II prescription after verbal consultation with the prescriber?

• a) The patient’s name
• b) The controlled substance prescribed
• c) The prescriber’s signature
• d) Dosage form, drug strength, and quantity, with proper documentation. Answer: d) Dosage form, drug strength, and quantity, with proper documentation.

46. The ethical concept of “paternalism” in healthcare, which is generally discouraged, occurs when a provider:

• a) Acts as a father figure by making decisions for the patient without their consent, believing it’s in their best interest.
• b) Involves the patient’s father in all decisions.
• c) Fully respects the patient’s autonomy.
• d) Provides all available information to the patient. Answer: a) Acts as a father figure by making decisions for the patient without their consent, believing it’s in their best interest.

47. A pharmacist who alters a prescription for a controlled substance without the prescriber’s authorization has committed:

• a) A legal and ethical violation.
• b) An act of good clinical judgment.
• c) A common pharmacy practice.
• d) A minor error with no consequences. Answer: a) A legal and ethical violation.

48. It is an ethical imperative for a pharmacist to stay current on the evolving laws and treatments for SUDs through:

• a) Guesswork
• b) Continuing professional development
• c) Asking patients for information
• d) Reading social media posts Answer: b) Continuing professional development

49. The legal basis for the “closed system” of controlled substance distribution is to:

• a) Make medications more expensive.
• b) Create a paper trail and maintain accountability from manufacturing to dispensing to prevent diversion.
• c) Limit the number of pharmacies that can dispense opioids.
• d) Ensure all medications are sold at the same price. Answer: b) Create a paper trail and maintain accountability from manufacturing to dispensing to prevent diversion.

50. The ultimate goal of navigating the complex legal and ethical issues of substance abuse is to:

• a) Avoid all risk and refuse to dispense all controlled substances.
• b) Punish patients who have SUDs.
• c) Protect the public, provide compassionate and effective care, and uphold the integrity of the pharmacy profession.
• d) Ensure the pharmacy makes the highest possible profit. Answer: c) Protect the public, provide compassionate and effective care, and uphold the integrity of the pharmacy profession.