When the Opioid Medications Go Missing: Confidentiality and Safety in Adolescents

Patients receiving end-of-life or palliative care usually possess an ample supply of opioid 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.