When a doctor sees a patient with a runny nose and body aches, the doctor may think it’s a cold or the flu. For patients with substance use disorder (SUD), these symptoms can indicate other complications related to their addiction.
Unfortunately, without access to an important health history, the link between common symptoms and SUD can be missed. As a result, doctors may prescribe a drug to an addictive patient who could put his life at risk or fail to send him home with a drug like naloxone that could save him. Amidst the resulting national drug overdose crisis Nearly 108,000 deaths last yearEvery interaction with the US healthcare system represents a critical opportunity for addiction treatment and management.
So why are there so many missed opportunities?
The reasons are complex, but one factor is federal law that has made it unnecessarily difficult for addiction professionals, like us, to share their patients’ medical records without first obtaining detailed patient consents—even for the purposes of coordinating their treatment and ensuring reimbursement for he-she. Because of a high-tech federal law and its implementing regulations called 42 CFR Part 2Addiction professionals often cannot share information that would identify a patient as having SUD without going through an extraordinarily rigorous licensing process for each detection.
When 42 CFR Part 2 first became law in 1975, It was intended to protect the privacy of patients with ADHD in settings outside of health care, such as in administrative or criminal proceedings.. Given the stigma and discrimination associated with addiction, the need for this type of confidentiality was, and remains, significant. Even today, law enforcement and probation officers regularly come to clinics like ours to obtain information about a patient’s medical history without the patient’s prior consent. Of course, we will never pass this sensitive information on to them without the patient’s permission or being legally required to do so. In this regard, the law is a successful guarantee and helps the medical staff to better protect the privacy of our patients.
However, decades later, the unintended consequence of other provisions of the law has been the dangerous shutdown of addiction care within the larger medical system, reinforcing barriers to safe and effective treatment for Americans living with SUD.
Cumbersome and confusing requirements created by federal regulations often prevent healthcare professionals from accessing the information they need to provide better care for patients with addiction. Without physicians across a patient’s health care team able to access complete information about the history of SUD and the medications used to administer it, approaches to diagnosis, treatment, and reimbursement can vary greatly. Even when a patient gives explicit permission to share SUD records, we often run into barriers that health systems put in place to avoid any chance of violating federal law.
Integrated care is the best practice in all areas of medicine. so far for 40 million Americans currently live with SUDThis coordinated approach is often out of reach due to these outdated privacy regulations. No other medical condition is governed by 42 CFR Part 2 – a fact that underscores the continuing stigma and discrimination that patients with addiction face when accessing health care.
Just imagine if 42 CFR Part 2 applied to heart disease. Rather than facilitating a cardiologist’s ability to share a patient’s heart history and medication list with other medical professionals involved in that patient’s care, the patient will bear the burden of completing multiple and complex consent forms or communicating these medical details from memory. Most people would agree that this would seriously undermine a physician’s ability to care for a patient—but that scenario often exists for Americans with addiction and the healthcare professionals who treat them.
To break down these barriers and improve coordination of care and safety for patients with SUD, we must update the federal privacy rules governing SUD records.
In March 2020, Congress passed Important bill for COVID-19 relief, which included provisions that would facilitate comprehensive and integrated care for people with addictions. The act called for 42 CFR Part 2 to be more closely aligned with the Health Insurance Portability and Accountability Act (HIPAA) – the federal law that governs the use and disclosure of other medical records. Congress has also passed provisions that protect patient rights in a number of ways, including by requiring the patient’s initial consent to share applicable SUD records, and prohibiting the use of these records in civil, criminal, administrative, or legislative proceedings against the patient, unless properly authorized. by a government authority. In addition, Congress has provided clear protections against discrimination with respect to health care, employment, housing, and important social services and benefits.
We are optimistic that these legal changes will improve coordination of care and safety for patients with addiction, while maintaining patient confidentiality. Going forward, the Biden-Harris administration must pass a powerful 42 CFR Part 2 to implement these long-overdue provisions. If we really want to popularize addiction treatment and save lives, we must also popularize the sharing of medical records.
Nzinga A. Harrison, MD, FASAM is a board member of the American Society of Addiction Medicine, an addiction specialist, and Chief Medical Officer and Co-Founder of Eleanor Health, a company built on equity and justice that develops mental health medical homes for individuals affected by substance use disorder.Paul H. Early, MD, DFASAM is a past president of the American Society of Addiction Medicine, addiction specialist, and person in long-term recovery.