Ethical Dilemmas in Substance Use Disorders (1.5 CME)

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(1.5 CME) In this conference recording from the 2019 Annual Conference, you will learn:

Ethical issues have become more prominent in caring for patients with addiction, with stigma contributing. Perceptions of substance use disorder as a patient choice continue to taint appropriate medical for patients with substance use disorders. Clinical dilemmas arise related to "difficult" patients, "manipulative" behavior, refusal of care (by patients and providers) and legal issues. The workshop will initially review the ethical principles of autonomy, beneficence, non-maleficence, justice, fidelity and futility, The understanding of these concepts will then be applied to patient case discussions.  Scenarios will include patients making perceived "poor choices", specialist refusal of care, "mandated" treatment, and organ transplantation in patients with substance use disorder. Participants will join small groups to discuss each patient scenario and develop an answer (there may not be just one right answer).  Participants will also have an opportunity to present their own patient dilemmas that pose ethical questions.  The session will help build clinical confidence, by building skill to make decisions in clinical situations using an ethical framework.

Learning Objectives:

1.) Upon completion, participants will be able to understand ethical principles in medical care
2.) Upon completion, participants will be able to demonstrate the ability to make decisions using an ethical framework
3.) Upon completion, participants will be able to educate colleagues on providing ethical care to patients with substance use disorder 

Michael Fingerhood


Dr. Michael Fingerhood is an Associate Professor of Medicine at the Johns Hopkins University. He is the Chief of the Division of Chemical Dependence and medical director of the Comprehensive Care Practice (CCP) at Johns Hopkins Bayview Medical Center. The CCP integrates substance abuse treatment with primary medical care, including care for HIV and hepatitis C.

Dr. Megan Buresh, MD

Assistant Professor of Medicine, Johns Hopkins School of Medicine

Dr. Megan Buresh is an Assistant Professor of Medicine and Epidemiology at the Johns Hopkins University School of Medicine.  She is board certified in internal medicine and addiction medicine and certified as AAHIVM HIV Specialist.  She received a Bachelor of Arts in Biochemical Sciences from Harvard University (magna cum laude with highest honors in field), completed medical school at Johns Hopkins University School of Medicine and residency at Brigham and Women’s Hospital.  She is the Secretary of the Maryland-DC ASAM Chapter.

She is medical director of the Johns Hopkins Bayview Inpatient Addiction Consult Service.  She also provides integrated buprenorphine treatment as part of her outpatient primary care practice.  She is lead physician for BHLI PCARE, a mobile buprenorphine clinic for patients being released from Baltimore City Jail.  Her research interests include public health and addiction, developing and evaluating models to expand office-based opioid treatment, and improving linkages between clinical addiction treatment and community organizations.  She is a co-investigator with the ALIVE study at the Johns Hopkins Bloomberg School of Public Health, where she is studying risk factors for opiate overdose and access to naloxone among persons who inject drugs.    

Jarratt D. Pytell


Jarratt Pytell, M.D., is the 2018-19 fellow in Addiction Medicine at Johns Hopkins. He received his undergraduate degree from the University of Colorado at Boulder in mathematics and psychology. Afterwards he was accepted into Teach For America and worked as a 7th and 8th grade math teacher at a public school located in New Orleans' Upper Ninth Ward. He then earned his medical degree from Louisiana State University Health Sciences Center, New Orleans. During medical school, he was accepted as an Applied Epidemiology Fellow at the Centers For Disease Prevention and worked for a year in the Division of Waterborne Diseases. He completed his medical residency at Johns Hopkins Bayview Medical Center. He will complete a General Internal Medicine fellowship at Johns Hopkins after completing his Addiction Medicine fellowship and plans to pursue a career in academic medicine focusing on the primary care treatment of substance use disorders and address health disparities in access to substance abuse treatment.

ACCME Accredited with Commendation

ACCME Accreditation Statement

The American Society of Addiction Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

AMA Credit Designation Statement

The American Society of Addiction Medicine designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credit(s).  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABPM Maintenance of Certification (MOC)

The American Board of Preventive Medicine (ABPM) has approved this activity for a maximum of 1.5 LLSA credits towards ABPM MOC Part II requirements.

ABAM Transitional Maintenance of Certification (tMOC)

This course has been approved by the American Board of Addiction Medicine (ABAM). Physicians enrolled in the ABAM Transitional Maintenance of Certification Program (tMOC) can apply a maximum of 1.5 AMA PRA Category 1 Credit(s)™ for completing this course.

ABIM Maintenance of Certification (MOC)

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn 1.5 Medical Knowledge MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.


Session Recording
Open to view video.
Open to view video. This session was recorded on 4/7/19 in Orlando, FL
CME Quiz
3 Questions  |  10 attempts  |  2/3 points to pass
3 Questions  |  10 attempts  |  2/3 points to pass Complete the quiz to claim CME.
CME Evaluation
15 Questions
15 Questions Please complete the evaluation to claim CME.
CME Credit and Certificate
Up to 1.50 medical credits available  |  Certificate available
Up to 1.50 medical credits available  |  Certificate available 1.5 AMA PRA Category 1 Credits