By Alison Knopf
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 take methadone or buprenorphine. Specifically, two proposals from the Substance Abuse and Mental Health Services Administration (SAMHSA) would lead to opioid treatment programs (OTPs) sending information about their patients to Prescription Drug Monitoring Programs (PDMPs).
“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 said he is concerned that enforcement authorities “will be emboldened to go back to some of their earlier ways of prosecuting patients.”
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.”
As Mr. Parrino has said often, “once this barn door is open, it will not be closed again.” The letter from the attorneys general simply underscores the importance of confidentiality protections, he said.
“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.”
NPRM — Regulatory Information Number 0930-AA32:
Deadline for submitting public comments: 5 pm October 25, 2019.