Proposed changes to rules governing the confidentiality of patient records created by federally assisted substance use disorder treatment programs are facing strong opposition from stakeholder groups.
Addiction treatment, healthcare and privacy rights organizations are raising the red flag regarding last week’s proposal from the Department of Health and Human Services—they contend that the rules would weaken the protections against unauthorized disclosures of a patient’s SUD treatment records.
Title 42 of the Code of Federal Regulations Part 2, which protects the confidentiality of SUD patient records, was passed by Congress in 1975 because of concerns about the potentially negative consequences that could result from disclosing such information.
But, with the opioid epidemic continuing to take the lives of Americans, HHS wants to revise 42 CFR Part 2 to facilitate better coordination of care for substance use disorders which the agency contends will also enhance care for opioid use disorder.
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However, members of the Campaign to Protect Patient Privacy Rights—which includes more than 100 stakeholder groups—charge that weakening confidentiality protections will serve to dissuade individuals who need SUD treatment from seeking care because of fear that their private health information would be used against them.
“In the midst of the worst opioid epidemic in our nation’s history, we cannot afford to have patients fearful of seeking treatment because they do not have faith that their confidentiality will be protected,” says Mark Parrino, president of the American Association for the Treatment of Opioid Dependence. “Patients are already anxious about the proposed new rule and the threat of opioid treatment programs sharing their sensitive health information through their state Prescription Drug Monitoring Programs, which may be accessible to entities like law enforcement who could then use the information to prosecute patients.”
“Many of us would not have gone to treatment or accepted services if we thought that our information would have been shared with other entities without our permission,” adds Patty McCarthy Metcalf, executive director of Faces & Voices of Recovery, an advocacy group. “We would not have put our careers, reputation or families at risk of stigma and discrimination if we were not assured that information about our substance use disorder was safe and would only be shared with our consent.”
However, HHS emphasizes that its goal in revising 42 CFR Part 2 is to remove any barrier someone might encounter to either choosing or providing appropriate treatment.
In addition, the agency insists that the “basic framework for confidentiality protection of SUD patient records created by federally assisted treatment programs will not be altered under the proposed rule” and that law enforcement will continue to be prohibited from using records in criminal prosecutions, while restrictions will remain in effect against disclosure of SUD treatment records without patient consent—unless an exception applies.
“The lack of critical substance use history in a patient’s medical record can lead to potentially damaging consequences for a person with a substance use disorder and can further stigmatize these conditions,” says HHS Assistant Secretary for Mental Health and Substance Use Elinore McCance-Katz. “This rule aims to ease the sharing of information, reduce burden for providers, and increase access to care for individuals while at the same time maintaining important privacy controls.”
Nonetheless, Paul Samuels, president and director of the Legal Action Center, an organization that fights discrimination against people with histories of substance use disorder, challenges that contention.
“The confidentiality rule is not a hindrance to the facilitation of effective services, but a necessary protection for individuals who would otherwise be susceptible to a multitude of detrimental consequences if their SUD information was disclosed without their permission to potential employers, housing providers, law enforcement, and more,” concludes Samuels.