{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T14:02:22Z","timestamp":1777384942559,"version":"3.51.4"},"reference-count":28,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,1,17]],"date-time":"2026-01-17T00:00:00Z","timestamp":1768608000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Hosp Palliat Care"],"DOI":"10.1177\/10499091261417605","type":"journal-article","created":{"date-parts":[[2026,1,17]],"date-time":"2026-01-17T16:39:59Z","timestamp":1768667999000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Ethics Roundtable: Prescribing Controlled Substances in a Terminally Ill Patient With Suspected Substance Abuse Disorder and Opioid Agreement Violations"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4902-8579","authenticated-orcid":false,"given":"Steven J","family":"Baumrucker","sequence":"first","affiliation":[{"name":"Ballad Health System"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa","family":"Broome","sequence":"additional","affiliation":[{"name":"Ballad Health System"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory T","family":"Carter","sequence":"additional","affiliation":[{"name":"Elson S Floyd College of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0540-7216","authenticated-orcid":false,"given":"Matt","family":"Stolick","sequence":"additional","affiliation":[{"name":"University of Findlay"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott P","family":"Boyles","sequence":"additional","affiliation":[{"name":"Ballad Health System"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregg","family":"VandeKieft","sequence":"additional","affiliation":[{"name":"Providence Swedish"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Wampler","sequence":"additional","affiliation":[{"name":"Ballad Health System"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lindsay","family":"Wilson","sequence":"additional","affiliation":[{"name":"Ballad Health System"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carolyn","family":"George","sequence":"additional","affiliation":[{"name":"Moffitt Cancer Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew A","family":"Murphy","sequence":"additional","affiliation":[{"name":"Moffitt Cancer Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saima","family":"Rashid","sequence":"additional","affiliation":[{"name":"Moffitt Cancer Center"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,1,17]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4637.2005.00072.x"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12094-025-03929-7"},{"key":"e_1_3_3_4_2","unstructured":"21 C.F.R. \u00a7 1306.04(a). In Addition There Is a \u201cCorresponding Responsibility [That] Rests with the Pharmacist Who Fills the Prescription.\u201d Id. See 21 U.S.C. \u00a7 829."},{"key":"e_1_3_3_5_2","unstructured":"United States v. Moore 423 U.S. 122 138\u201343 (1975)."},{"key":"e_1_3_3_6_2","unstructured":"21 C.F.R. \u00a7 1306.04(a). The diversion control division of the DEA offers information on its website: https:\/\/www.deadiversion.usdoj.gov\/ (accessed Dec. 9 2025)."},{"key":"e_1_3_3_7_2","unstructured":"See 21 U.S.C. \u00a7 842; 21 U.S.C. \u00a7 841(a); Moore 423 U.S. at 143."},{"key":"e_1_3_3_8_2","volume-title":"Clinical Practice Guideline for prescribing opioids for pain \u2014 United States","author":"Centers for Disease Control and Prevention","year":"2022","unstructured":"Centers for Disease Control and Prevention, Clinical Practice Guideline for prescribing opioids for pain \u2014 United States. Centers for Disease Control and Prevention, 2022."},{"key":"e_1_3_3_9_2","unstructured":"See DEA Practitioner\u2019s manual (2020)."},{"key":"e_1_3_3_10_2","unstructured":"AMA Code of Med. Ethics op. 2.2.1; op. 2.2.4."},{"key":"e_1_3_3_11_2","unstructured":"AMA Code of Med. Ethics Op. 3.2.1. consistent with this the health insurance portability and accountability act (HIPAA) regulations expressly permit disclosure to law enforcement when a crime is suspected allowing physicians to report opioid diversion as outlined more specifically in endnote 16."},{"key":"e_1_3_3_12_2","unstructured":"45 C.F.R. \u00a7 164.512(f). Note that this is a permissive report but not a mandatory one."},{"key":"e_1_3_3_13_2","unstructured":"AMA code of medical ethics Op. 1.1.5."},{"key":"e_1_3_3_14_2","unstructured":"See generally Am. Coll. of Physicians Stmt. On opioid misuse and clinician duties (2017)."},{"issue":"1","key":"e_1_3_3_15_2","first-page":"63","article-title":"Ethical issues in palliative care","volume":"21","author":"Emanuel SEJ","year":"2013","unstructured":"Emanuel SEJ Ethical issues in palliative care. J Clin Oncol. 2013;21(1):63-78.","journal-title":"J Clin Oncol"},{"key":"e_1_3_3_16_2","unstructured":"45 C.F.R. \u00a7 164.502(a)."},{"key":"e_1_3_3_17_2","unstructured":"HIPAA allows disclosure of PHI that the provider believes in good faith constitutes evidence of a crime on the premises of the provider. 45 C.F.R. \u00a7 164.512(f)(5). This exception is narrow typically limited to illegal activity occurring in the clinical setting such as a hospital. Also HIPAA permits limited disclosure when the provider has information that \u201cconstitutes evidence of criminal conduct.\u201d 45 C.F.R. \u00a7 164.512(f)(3). Thus a provider could report opioid diversion if there is a good-faith belief that criminal diversion exists. In addition HIPAA allows disclosure when it could prevent a serious and imminent threat to health or safety. 45 C.F.R. \u00a7 164.512(j). This provision is very narrow and is not likely to apply in Most patient care contexts. Finally HIPAA allows disclosure when required by another law such as a state reporting obligation. 45 C.F.R. \u00a7 164.512(a). While It Is Important to Confirm the Jurisdictional Requirements Generally States Do Not Impose Mandatory Reporting Requirements for Prescription Diversion."},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2015-0012"},{"key":"e_1_3_3_19_2","volume-title":"In the Realm of Hungry Ghosts: Close Encounters with Addiction","author":"Mat\u00e9 G","year":"2010","unstructured":"Mat\u00e9 G. In the Realm of Hungry Ghosts: Close Encounters with Addiction. 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