Federal health officials have proposed a revamp of the strict patient confidentiality rules enacted in the 1970s. The revamp’s purpose is to allow coordination among medical professionals offering treatment to victims of the widespread opioid epidemic. A patient’s consent will still be required to share this information.

According to Health and Human Services Secretary Alex Azar, these reforms aim to ease the process of sharing a patient’s drug treatment history with doctors treating a drug addiction victim for other medical problems. Azar insists that this information sharing is important and can prevent serious and sometimes fatal errors. Think about when a doctor unsuspectingly prescribes opioid painkillers to a surgical patient with a history of dependence.

The Secretary feels that change is necessary to get a breakthrough in mental health treatment. An alliance of closely 50 groups, made up of mental health professionals, insurers, hospitals, and pharmacists, has been insistent on a change. This push enjoys bipartisan backing in Congress.

A brief history of confidentiality rules

In the early 1970s, Congress acknowledged the stigma associated with substance abuse and that fear of prosecution stopped people from seeking addiction treatment. Congress enacted legislation to allow clients in a substance abuse treatment program a right to confidentiality (42 USC §290dd-2). These are commonly called Federal confidentiality regulations (42 C.F.R. Part 2, or Part 2). It has been a foundation practice for substance abuse treatment programs nationwide.

Primarily, confidentiality rules exist to reassure individuals pursuing drug treatment from federally funded programs that their medical information is not shared with police. But the paper-era rules haven’t caught up in the age of electronic records and doctor-patient communication via text message.

What information was protected?

· Information about any individual who has applied for or received any substance-abuse-related assessment, treatment, or referral services, and all information about that person is not exactly permitted by nine limited exceptions.

· More restrictive of communications in many instances than either the doctor-patient or the attorney-client privilege.

· Current and previous clients from the time they make an appointment and apply to any information that would identify them as individuals who use substances directly or by implication.

· Clients who are directed into treatment as well as those who enter treatment voluntarily

· On whether the person searching for information already has that information, has other means of obtaining it, has some official status, is ratified by State law, or comes armed with a subpoena or search warrant.

Is the change of original rules necessary?

According to Azar, “This was all well-meaning.” “The idea was people wouldn’t seek treatment if they feared that information would be available to law enforcement. (But) a highly restrictive regime on the control of that information has served as a barrier to safe, coordinated care for that same patient.”

Azar gave a typical example of what could happen when addiction treatment is not disclosed in patient’s files. Imagine a case where a hospital doctor sees a patient who is on treatment for heroin addiction using methadone. The doctor may decide not to mention the methadone treatment in the patient’s record, perhaps with a concern that it could prompt official scrutiny of the hospital’s own records system. At a later date, another doctor treating the same individual might prescribe another drug that’s not safe to take with methadone, as are most anti-anxiety medications. Such exclusions could have serious ramifications for the patient.

The downside is that many patients communicate with doctors via text messages; the 1970s privacy rule has generated unanticipated problems. For instance, when a doctor receives a text from a patient in a recovery program, does the doctor’s phone have to be electronically wiped or smashed to safeguard sensitive information? The new rule would make clear that such texts can be deleted.

Azar insists that the proposal will uphold privacy protections for people getting addiction treatment through federally funded programs. The patient will still have to give consent on whether the information can be shared.

What does the revamp mean for addiction treatment?

Of course, the concerns that led to the enactment of these confidentiality rules still exist. It may mean that people and especially teens and ex-convicts, may be afraid to come forward to seek drug addiction treatment. This is for fear of stigmatization or being reported to authorities. This might mean the mental health department may suffer blows by having lesser people signing up for treatment.

Some lawmakers, the insurance community, and health providers seek expansion of the proposed changes to make it easier to navigate the heavily guarded substance use treatment privacy requirements of Part 2 and the broader HIPAA.

On the positive side, though …

· The proposed changes “are common-sense, responsive changes to concerns that both patients and providers have raised regarding providing holistic, collaborative, patient-centered care,” according to Health and Human Services Secretary Alex Azar.

· The risk of prescribing drugs that could affect the person’s health under substance abuse treatment is real and could be fatal. In the wake of the sky-rocketing opioid abuse crisis, it is important that this information is shared among practitioners to protect clients’ lives.

· It will also help develop rules applicable in an era where electrical documents and digital communication are in use. Therefore doctors and facilities do not have to be in a dilemma about how they handle substance abuse treatment information

The proposal will be open for public comments for 60 days after publishing in the Federal Register. The revamp is based on a recommendation by President Donald Trump’s commission on the opioid epidemic.

What is your opinion? What are your dilemmas or fears as someone under a treatment program, planning to enroll in one, or have a loved one in this situation? We will be providing more updates and our views on this proposal, so visit us often and get more insights about the issue.

Sources

https://www.washingtonpost.com/politics/feds-to-revamp-confidentiality-rules-for-addiction-treatment/2019/08/22/e7c27930-c519-11e9-8bf7-cde2d9e09055_story.html

https://www.ncbi.nlm.nih.gov/books/NBK64176/

https://news.wttw.com/2019/08/23/feds-revamp-confidentiality-rules-addiction-treatment