Dr Melvin WuSenior Resident PhysicianAddiction Medicine DepartmentInstitute of Mental HealthEthics In Addiction

Ethical Issues

Our Role: Physician or Law enforcementPatient is here for treatmentIs reporting/notifying part of treatment?Doing more than we should?

Patient confidentialityIs reporting/notifying a breach of confidentiality?

RapportWould reporting/notifying affect Doctor-Patient relationship?

Considerations

Misuse Of Drug Act

requiring any medical practitioner who attends to a person whom the medical practitioner considers or has reasonable grounds to suspect is addicted to any controlled drug to furnish to the prescribed authority such particulars with respect to that person as may be prescribed

Interpretation: Not necessary to have a positive Urine Drug ScreenSo long as the patient admits to using an illegal drugUrine drug screen shows a positive and patient is likely to have used it

Chapter 185 Section 58 Subsection 1 (e)

Types of Drugs/Substance to reportIllegal drugs: Heroin, Morphine*, Methadone*, Subutex (Buprenorphine), Marijuana (Cannabis, Ganja, Weed), Ecstasy, Ketamine, Amphetamines, Methamphetamine (ICE), Mephedrone, LSD, GHB (Gamma hydroxybutyric acid.)

Illegal Benzodiazepines: Erimin (Nimetazepam)*, Temazepam*, Upjohn (Triazolam), Rohypnol (Flunitrazepam)

*Considered legal if it is prescribed for the patient by a SMC registered doctor.

What Not To ReportInhalants (Intoxicating Substance Act)Dormicum (Midazolam)Cough Mixture

* Chapter 234: An Act to regulate the importation, possession, manufacture, compounding, storage, transport and sale of poisons.HSA Poison Act *}

Discussion of Considerations

Our Role: Physician or Law enforcementPatient is here for treatmentIs reporting/notifying part of treatment?Doing more than we should?

Law of the land has to be obeyedMisuse of Drug ActCriminal Procedure Code (Chapter 68, Section 20)Power to order production of any document or other thing

Carrying out the duty as a citizen of the land

Patient confidentialityIs reporting/notifying a breach of confidentiality?

Law of the land supercedes confidentiality

Confidentiality can be breached if there is harm to self or harm to others

RapportWould reporting/notifying affect Doctor-Patient relationship?

No obligation to inform patient

Depends on the delivery method of messageIm going to have to report you to the authoritiesUnfortunately, I am obliged by the law to have to notify CNB. But do not worry as we have learnt from the other patients that CNB usually does not do anything with the notification. We think that they would use this notification as a way to gauge the severity of the drug use problem in Singapore.This notification can help you to remember that you are on their radar and use this fact as a deterrent reason for you not to start using again.

Case Discussions

Mr DEF, a pilot for a major airline, seeks help for alcohol addiction. At times, would sneak a drink when he is on long-haul flights to prevent withdrawal tremors.

Mr GHI, a taxi driver. Drinks after his shift. Denies driving after drinking. History corroborated with wife.

Mr GHI, seeking help for Pornography addiction. Claims that he had touched young kids inappropriately 5 years ago. Has never been caught or charged.