Dr. Janssen has been treating Eli Lily for the past year. During a recent session, Mr. Lily stated that he had been having financial problems. When queried by Dr. Janssen, Mr. Lily detailed that he can sell his medication to co-workers and neighbors. Dr. Janssen asked a few other questions, then Mr. Lily changed the subject. While writing notes, Dr. Janssen reviewed note from the initial intake. Mr. Lily takes a variety of controlled substances, including Adderall for ADHD and Ambien for insomnia. Mr. Lily receives these prescriptions for Adderall and Ambien, as well as other medication, from his physician’s associate (PA).
At the next session, Dr. Janssen asked more questions about the medications he had been selling. Mr. Lily reported he sells Adderall and Ambien intermittently. However, Mr. Lily has had a medical marijuana card and has being selling various forms of medical marijuana on a regular basis to friends and family. Mr. Lily obtained a medical marijuana card through a process independent of the PA, and indicated the PA does not know about the medical marijuana.
Dr. Janssen in clearly concerned about these legal and clinical issues. Dr. Janssen wants to just forget he asked these questions, but calls you for a consultation.
What are the ethical issues involved in this case?
What are the clinical issues involved in this situation?
What are the ramifications about the therapeutic relationship?
What courses of action would you suggest to Dr. Janssen?
