Source: http://healthaffairs.org/blog/2017/04/13/discrimination-against-patients-with-substance-use-disorders-remains-prevalent-and-harmful-the-case-for-42-cfr-part-2/
Timestamp: 2017-07-25 14:51:20
Document Index: 209925678

Matched Legal Cases: ['art 2', 'art 2', 'art 2', 'art 2', 'art 2', 'art 2', 'art 2', 'art 2', 'art 2', 'art 2', 'art 2', 'art 2']

Associated Topics: Population Health, Public Health, Quality Discrimination Against Patients With Substance Use Disorders Remains Prevalent And Harmful: The Case For 42 CFR Part 2
Associated Topics: Population Health, Public Health, Quality Tags: 42 CFR Part 2, HIPAA, opioid epidemic, patient discrimination, patient privacy, substance use treatment	Comments
No Trackbacks for “Discrimination Against Patients With Substance Use Disorders Remains Prevalent And Harmful: The Case For 42 CFR Part 2”
11 Responses to “Discrimination Against Patients With Substance Use Disorders Remains Prevalent And Harmful: The Case For 42 CFR Part 2”
I am a rural psychiatrist and run an addiction clinic, currently at maximum waivered number of 275 Suboxone patients. I have four sober living houses. The regulatory burden of 42 CFR Part Two and other federal and state regulations is stagnating creative solutions as is the grant game of temporary money for temporary programs addressing permanent problems. The amount of time and money we spend on “compliance” is staggering. I could have saved hundreds of more lives with that time and money. The people writing burdensome regulations have good intentions but life cannot be fixed with bureaucracy. This is the reason we spend twice as much as other countries for inferior outcomes. “Do gooders” are making it difficult to do good.
L. Kielhorn,MD says:
I’m very disappointed there isn’t any protection for the unborn child when exposed to ongoing illicit addictive drugs in the State of Michigan. The mother should be required to go inpatient for treatment.
I want to thank Karla Lopez and Deborah Reid for reinforcing the important principle that a patient receiving care for a substance use disorder should retain the right to determine who gets to know that information. Lopez and Reid detail with critical specificity the adverse consequences of disclosure of this information. They also make it clear from their examples that the issue includes both alcohol and drugs.
With regard to prescription opioids, clinicians have access to prescription drug monitoring programs (PDMPs). And, while PDMPs are not integrated into the electronic health record, any patient receiving a Scheduled drug covered by the PDMP will have that information presented to the clinician. And, while opioids aren’t the only substances of concern from a clinical perspective, they are also not the only substances covered by PDMPs.
Lopez and Reid also challenge the fiction that HIPAA is an adequate substitute for 42 cfr part 2. Their account demonstrates that it is not.
Many cite the current opioid crisis as a justification for throwing out 42 cfr part 2, I submit that the opioid crisis is the very justification for keeping 42 cfr Part 2. We should be encouraging people to enter treatment; we should be promoting prevention, as well. However, knowing that you self-disclosure will incriminate you and increase your risk for poor treatment is not an incentive for self-disclosure. To the contrary, it promotes deception, something that we should be trying to avoid. Lopez and Reid are correct. First, do no harm by eliminating the regulatory and legal discrimination and punishment of those with substance use disorders. Then, revisit 42 cfr part 2.
Many thanks to the authors for this blog post. I could not agree more about the importance of maintaining protections for people seeking help for substance related concerns. In our fast-paced technology driven world it can be too easy to release information that would be detrimental to the individual and their family. Until the legal repercussions associated with substance use and substance use disorders are eliminated, 42 CFR Part 2 must remain to protect people seeking care.
April 23rd, 2017 at 9:21 pm
People who are charged of substance abuse should not be given the previous free rights either. If they were sane enough then they should not be taking drugs in the first place. However, bad decision making can lead to catastrophic effects. You are absolutely spot on that lack of disclosure can lead bad decision making and as a result will harm the patient`s health nonetheless. The most important point is protection against discrimination which is increasing whatsoever. April 20th, 2017 at 3:08 am
People who are charged of substance abuse should not be given the previous free rights either. If they were sane enough then they should not be taking drugs in the first place. However, bad decision making can lead to catastrophic effects. You are absolutely spot on that lack of disclosure can lead bad decision making and as a result will harm the patient`s health nonetheless. The most important point is protection against discrimination which is increasing whatsoever.
It is a behavioral disorder. The disease process is a consequence of the disorder continuing. The neurobiological upset that predisposes an individual to continue to engage in the behaviors is complex. The discrimination is real but we need to also need to protect 42CFR part 2 by getting anyone working with the charts of these individuals to understand that the addiction counselor is the person who determines disclosure. If it is not in the best interest of the client, an addiction counselor could refuse that disclosure and more fully provide client information on the need to know importance. In addition, HIPAA complicates situations to get positive social supports engaged in treatment process and create the family treatment or community supports needed to move forward. For example agencies requiring the client to be physically in the office to talk with collaterals does not work well.
Thank you so much for this important explanation about 42 CFR part 2. As a physician, I can confirm that discrimination is alive and well in the medical community. Until we truly treat addiction as the disease that it is, and stop locking people up when they need help, we will not succeed in stemming the epidemic. The war on drugs was an abject failure, and yet, due to the persistent prejudice about addiction, policies that impose harsh penalties on people for possessing heroin are being passed at the local level and proposed at the federal level. When will we finally adopt the public health approach that is so sorely needed?
Bill needs to read part 2.53 before he is held in contempt.
i could not agree more. As someone who has fallen to addiction due to a motorcycle accident. My dr started me on heavy heavy prescription opiods and my use of them seriously accelerated to a very deadly combination of my meds and the life i was having to live being on heavy narcotics. As well as my overall life just completely was turned upside down. I have been in a suboxone treatment program for the last year and my quality of life is starting to improve. I am however still dealing with the consequences from my use. Doctors and other medical professionals need to be more understanding of this disease. I would not wish opiate addiction on my worst enemy. And to the ones who judge and have never experienced this horror need to shut their mouths until they have experienced it themselves or have had someone close to them deal with it because as most opiate addicts in recovery know their use never only affects themselves, it has a mass effect on everyone around them. April 13th, 2017 at 12:21 pm
Your post nailed the differences in 45 vs 42 and adverse consequences from disclosures. HIPAA is porous whereas 42 is opaque. In my experience the Criminal Justice system is clueless of 42 provisions. Once, after informing a DA I could not release patient records on a subpoena per 42, she asked me what it said. I suggested she familiarize herself with it. She replied “I don’t have time, I need those records to see if a crime was committed”.