Privacy Laws and Addiction – 42 CFR part 2
The question of privacy laws and how they conflict with addiction treatment is a challenging issue for those in the medical industry. The Surgeon General Vivek Murthy released an eye opening report on substance abuse disorder in the U.S. on November 17, 2016. The document explains the detrimental toll of drug and alcohol abuse on the nation. One of the challenges is to fight the stigma for those suffering from substance abuse disorder. To fully implement this now is nearly impossible due to an old federal policy law known as 42 CFR part 2.
How 42 CFR part 2 Privacy Laws Create Challenges for Addiction Treatment
In 1987, 42 CFR Part 2 was implemented as a direct response to the stigma and fear that addicts might not seek help because they were afraid of prosecution. This was due to the 1970’s and 80’s painting a grim picture of substance use disorders. Misuse of drugs at the time were considered moral failings so people were ashamed to seek treatment. The implementation of 42 CFR part 2 requires addiction treatment providers to get written consent from patients. The law hasn’t been adjusted so it still stands that if clinicians don’t get consent from patients, they’re powerless in sharing information with non-addiction clinicians unless it’s an emergency.
This confidentiality clause to protect patients from being judged due to the stigma of substance abuse is causing roadblocks. The kind of roadblocks that make it more challenging for medical clinicians to best help people with addiction treatment. The protection, which was supposed to be a benefit is preventing good medical care.
Privacy Laws Preventing Proper Addiction Treatment
It was in 1987 that 42 CFR part 2 was implemented, before the Health Insurance Portability and Accountability Act of 1992 (HIPAA). Part 2 and HIPAA guidelines contradict each other, protecting patients that could otherwise be helped by the right people.
Part 2 Prevents Positive Addiction Treatment because,
- It was designed at a time where addiction treatment was a segregated system.
- The law behind Page 2 prevents addiction treatment being implemented into mainstream medicine.
- An addiction medicine physician, who is also a general practitioner, gives addiction treatment medication to a patient in a doctor’s office. HIPAA protects the records of the addict’s care. So, the same doctor will not have access to essential records if the patient comes in for example, opioid detox in a addiction treatment clinic.
- However, when the patient comes in to a doctor’s office for addiction treatment, Part 2 laws ensure that the addicts information is public to other clinicians.
- Here’s what the scenario might look like. A patient who has an opioid use issue may go to a physician who doesn’t know about their addiction and prescribe opioids unknowingly because they aren’t privy to their information.
- The law of Part 2 also perpetuates the stigma that started way back in the 1970’s. It sends a message that this information is secret because it’s shameful and separate from other diseases.
Why Privacy Laws for Addiction Treatment Don’t Work
Not only has our society seen major advances since Page 2 was implemented back in 1987 but of course the medical industry has pushed forward also.
In relation to substance abuse disorder, more health care settings are involved than they were in past decades. There are not only various acute recovery options but emergency departments, trauma units and primary care clinics. The electronic era is making it easier to integrate substance abuse disorder treatment with more general forms of help in the health care industry. So while the technology is there to support the updates in privacy laws for those with alcohol or drug misuse, the laws don’t match. The nature of how substance abuse is delivered has changed but without official laws changing, it hasn’t changed the general stigma significantly enough.
How SAMHSA is affecting Privacy Laws and Addiction
On January 18, 2017, the first major revisions to federal regulations relating to substance use disorder patients’ records were finalized. They will modernize regulations based on the advances of the health care system.
The same day, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued a supplemental notice of proposed rulemaking. SAMHSA has requested comments on the disclosure of 42 CFR Part 2 so there’s more transparency for involved parties. These parties include; contractors, legal representatives (for carrying out payment), and health care operations.
While the final rule is in favour of these changes, Part 2 is still applicable to any clinic or program that is an addiction treatment provider.
Here’s a more detailed list of the updated changes that will take place as of May 31, 2017:
- The new patient consent forms allow them to authorize a General Disclosure to other entities like addiction treating providers and health information exchanges.
- Patient consent forms must have the right amount and type of information. This includes diagnosis information, medications and dosages, lab tests, substance use history summaries, living situation and other relevant information to help clinicians assist the patient best. The patient can also choose the option “all my substance use disorder information.”
- A Qualified Services Organization will be able to provide health management services. Their designation is to increase the health outcomes and conditions of groups affected by certain afflictions, including addiction.
- The prerequisite for health care providers to become Part 2 programs is not just providing screening, giving a brief intervention or referral to a treatment.
- A re-disclosure provision only will only apply to information that is essential to the diagnosis, treatment, or referral for a substance use disorder.
- If there is a medical emergency, confidential information can be disclosed with no consent needed.