The Substance Abuse and Mental Health Services Administration (SAMHSA) wants to change its regulation requiring patients to consent to the release of their substance use disorder (SUD) treatment records. According to the SAMHSA proposal, which is now in the Office of Management and Budget and titled “Coordinating Care and Information Sharing in the Treatment of Substance Use Disorders,”
The agency “is proposing broad changes to Confidentiality of Alcohol and Drug Abuse Patient Records, 42 Code of Federal Regulations (CFR) 2, also known as 42 CFR part 2 to remove barriers to coordinated care and permit additional sharing of information among providers and part 2 programs assisting patients with substance use disorders (SUDs).” Many doctors have complained for years that they don’t know if their patients are taking methadone, and therefore don’t know what medications are safe to give them. They say 42 CFR Part 2 imperils care. But as patient groups well know, they don’t want their information to be shared without their consent. Stigma and discrimination still prevail.
The consent provision is what is left after repeated sub-regulatory changes in the regulation; that’s because it’s required by statute, something only Congress can change. And now, because doctors and electronic health record (EHR) systems are hungry to know who is on methadone, it is Opioid Treatment Program (OTP) patients who are most afraid of changes. Even buprenorphine patients, when not treated in an OTP, are not protected, because their information goes into the state’s Prescription Drug Monitoring Program (PDMP), which doctors can check. In 2011, a “Dear Colleague” letter from H. Westley Clark, M.D., J.D., then director of the SAMHSA Center for Substance Abuse Treatment, told OTPs they should not put patient information into the PDMP, but they should check it for their patients. This has stymied the wishes of doctors in the country to find out who is on methadone, as well as thrown a wrench in the works of electronic health records that want everything about patients to be computerized. With this latest move by SAMHSA, Clark, now Dean’s Executive Professor at Santa Clara University, drafted a letter to Congresspersons and Senators urging that they not pass legislation weakening 42 CFR Part 2. Such legislation, he notes, would deter patients from seeking treatment – right in the middle of an opioid crisis. He also discusses the harms to patients from record disclosure. Also see https://atforum.com/2011/11/csat-accessing-prescription-drug-data-to-maximize-otp-patient-safety/
The Legal Action Center supports Dr. Clark’s work to encourage people to engage their Senators and Representatives on the importance of preserving strong privacy protections and we will soon be issuing a similar alert, which will include a link to Dr. Clark’s letter on the AT Forum website.