AATOD Issues Prescription Monitoring Program Guidelines for OTPs

The American Association for the Treatment of Opioid Dependence (AATOD), issued guidance this June to opioid treatment programs (OTPs) encouraging them to “utilize prescription monitoring programs (PMPs) as an additional resource to maximize safety in patient care pursuant to applicable state guidelines.”

When OTPs do access state PMP data bases, they should do so for therapeutic reasons, not for the purpose of restricting access to treatment, according to AATOD. “OTPs are discouraged from using such data for the sole purpose of restricting treatment access or for responding in a punitive fashion to the needs of patients in treatment.”

OTPs Should Not Report Confidential Data

OTPs, because of confidentiality law applying specifically to treatment for addiction, should not report anything that could identify their patients to PMPs, said AATOD, citing guidance from the Substance Abuse and Mental Health Services Administration (SAMHSA). Under 42 CFR Part 2, the federal regulation protecting the confidentiality of substance abuse treatment records, treatment programs may not divulge patient-identifying information without the patient’s written, specific consent. That was the point SAMHSA’s H. Westley Clark, MD, JD, was making in his September 27, 2011 Dear Colleague letter (See AT Forum Fall, 2011). SAMHSA administers 42 CFR Part 2.

However, no patient consent is required for the OTP—or anyone else—to request information from the PMP about a patient. Under 42 CFR Part 2, making such a request does not constitute disclosing a patient’s status as a substance abuse treatment patient.

But AATOD does recommend that OTPs notify a patient when they are accessing a PMP database, even though SAMHSA says this isn’t necessary. “The OTP should inform patients that they are accessing PMP databases by posting information or by distributing information to patients, explaining what a PMP does and why the program is requesting the data,” according to AATOD.

SAMHSA is expected to issue additional guidance on PMPs to OTPs.

According to AATOD, there are concerns that some people want to weaken 42 CFR Part 2 to make it possible for other physicians to access information about OTP patients. “As I understand it, someone from the Centers for Disease Control and Prevention may have recommended this idea about one year ago,” Mark W. Parrino, MPA, AATOD president, told AT Forum in an e-mail. “I also know that a number of physicians who work in emergency rooms have made similar recommendations.”

If a PMP re-discloses identifying data to interested parties about a patient, individuals could be discouraged from accessing medication-assisted treatment, according to AATOD.

So far, 49 of the 50 states either have active PMPs or legislation approving the use of PMPs.

The AATOD Guidance document can be accessed at: http://aatod.org/guidance_to_otps.html