The American Association for the Treatment of Opioid Dependence (AATOD) is concerned about recent initiatives that would reduce confidentiality for patients with opioid use disorder (OUD) who are being treated with methadone or buprenorphine. Specifically, two proposals from the Substance Abuse and Mental Health Services Administration (SAMHSA) would result in information being sent by opioid treatment programs (OTPs) about their patients to Prescription Drug Monitoring Programs (PDMPs). AT Forum interviewed the heads of AATOD and NAMA, the organization representing methadone and buprenorphine patients, for their comments on these proposals.
“If OTPs are compelled to disclose patient information to PDMPs, that information will surely leak into various electronic health record systems and enforcement authorities,” Mark Parrino, MPA, AATOD president, told AT Forum. “I cannot imagine that there will be an effective method of preventing this exposure, regardless of what the supporters of such conversion think,” he said. “Consider for a moment how banks and credit card companies, in addition to secure government agencies, are regularly hacked. This barn door will be impossible to close once it is open.”
Mr. Parrino is concerned that enforcement authorities “will be emboldened to go back to some of their earlier ways of prosecuting patients.” he said.
The SAMHSA proposals, published in the Federal Register August 26, came on top of a sign-on letter released in August by 38 state attorneys general calling for weakening 42 CFR Part 2 by making it like HIPAA.
Keeping the Barn Door Closed
“I find it to be of interest that the attorneys general have a stake in weakening the core confidentiality protections,” said Mr. Parrino. “I do not believe that their interest is in expanding access to treatment for opioid use disorder as much as it is accessing currently protected patient information. Think about police vans parked in front of OTPs on a Friday afternoon. Think about enforcement authorities accessing PDMP information and cross-referencing outstanding warrants.”
“The fact that the attorneys general have any position on why existing training for medical practitioners under DATA 2000 should be removed is even more strange,” added Mr. Parrino, noting that these are the same people who are “prosecuting pharmaceutical corporations and related entities because of their role in creating the opioid epidemic.” Instead, the physicians who wrote the opioid prescriptions should be viewed as part of the problem, said Mr. Parrino. “Surprisingly, the same attorneys general think that the very physicians who helped create the epidemic do not need any additional training to help treat opioid use disorder because they had such great medical training in how to prescribe opioids to treat pain. If this is not a case of chutzpah, I do not know what it is.”
There are also proposals in Congress to make 42 CFR Part 2 like HIPAA.
But the immediate concern is the NPRMs.
The patient community is extremely concerned about the proposal that would allow law enforcement to have access to all patient records. “I do not agree with the changes to Section 2.63 in this NPRM and ask that SAMHSA does not change this section or finalize this proposal,” said Zac Talbott, CMA, president-elect of NAMA Recovery.
“This change is a fundamental and substantive change to privacy regulations that will allow my personal health information to be shared outside the healthcare system for criminal justice purposes,” he said. The purpose of 42 CFR Part 2 is to protect patients and their health data, he added. “A change of this nature will deter people in need of treatment from seeking care out of fear of law enforcement involvement, which goes against the fundamental purpose of 42 CFR part 2.”
The change to Section 2.63 would encourage a “fishing expedition” by law enforcement looking for drug-related crimes by all patients, said Mr. Talbott.“ As both an individual in long-term, sustained, medication-assisted recovery, as well as a social worker, alcohol and drug abuse counselor, and clinical supervisor who has operated OTPs, worked in intensive outpatient substance use treatment services, and who now oversees behavioral health services across seven comprehensive office-based opioid treatment (OBOT) programs, I am extremely alarmed by this almost clandestine effort to broaden the interpretation of Section 2.63.”
For the law enforcement NPRM — Regulatory Information
Deadline for submitting public comments:
5 p.m. on Sept. 25, 2019.
For the general NPRM — Regulatory Information
Deadline for submitting public comments:
5 p.m. on Oct. 25, 2019.