Is Confidentiality Compromising Care? Symposium to Look at CFR 42 Part 2

Three addiction medicine professionals will sift through the complexities and divided opinions of current patient privacy regulations during Symposium 9, “CFR42.2 and the EMR: Necessary Protection or Barrier to Coordinated Care?” from 4:30 to 6:30 pm Saturday in Orange Ballroom D, Lower Level.

The session will feature Gavin Bart, MD, PhD, H. Westley Clark, MD, JD, MPH, and Eric Goplerud, PhD, MA. Each will explore the special privacy protections afforded to substance use disorder patient records through Code of Federal Regulations (CFR) 42 Part 2. The session is likely stir up a strong debate, Dr. Goplerud said.

“This will be an interactive discussion about an issue that doesn’t necessarily have a single, right answer,” he said. “It’s a controversial topic, but one that presents good points on all sides.”

The code’s provisions were designed to reduce the stigma and fear of prosecution an individual faces in seeking treatment for substance use disorders. Specifically, the regulations provide additional protection by outlining limited circumstances in which a patient’s treatment can be disclosed with and without that patient’s consent. Determining who is covered and to what extent is complex, Dr. Goplerud said, and many clinicians are confused by the regulations.

CFR 42 Part 2 applies to individuals or entities receiving federal assistance that provide alcohol or drug abuse diagnosis, treatment, or referral for treatment. Most drug and alcohol treatment programs receive federal assistance and must follow federal regulations, but for-profit and private practitioners are not required to comply with the regulations, unless they use a controlled substance for detoxification or maintenance treatment of a substance use disorder, in which they are required to obtain a federal DEA registration.

Additionally, CFR 42 Part 2 regulations restrict the disclosure and use of patient records in connection with programs receiving federal assistance, particularly in relation to identifying a patient for a substance use disorder. Written patient consent is required for disclosure of protected health information, even for the purpose of treatment, payment, or health care operations.

“Certainly, protecting the privacy of patients is a top priority, but the restrictions are creating barriers for treatment,” Dr. Goplerud said. “Under current regulations, clinicians face even greater challenges in treating patients, ultimately affecting quality of care and patient safety.”

For example, without patient consent, negative drug interactions can occur when providers don’t have the medical records they need to make informed decisions, he said.

“A substance use disorder is an illness. Those substances can interact with treatment drugs, putting the patient in harm’s way. The simple fact is that we are still operating under a 1975 law,” Dr. Goplerud said.

The symposium will explore a number of other controversies related to this regulation, including the stigma of being identified for an addiction and how it impacts patient care in the general health care setting. Current evidence supports the assertion that when information about a patient’s addiction is disclosed in the health care setting, the quality of care is generally poorer, he said.

“We know that patients feel their providers treat them differently once they are identified for a substance use disorder,” Dr. Goplerud said. “These are very legitimate concerns, so we also need to make education a component of any changes in the law.”