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    Opinion: Substance use disorder privacy law limits both payers, prescribers

    In a healthcare society where we are focused on increasing transparency, driving accountable care and the best patient outcomes, we continue to be fraught with obstacles to integrated care delivery. Some of the most cumbersome barriers include those that protect patients from disclosure of their substance use disorder, including any pertinent treatment for their chronic disease.

    Enacted in 1987, 42 CFR Part 2 was designed to protect the confidentiality of those who seek treatment for drug and alcohol use disorder.

    While drug overdoses were a concern at that time, three decades later, drug overdoses have become the single-largest cause of injury-related death in the country. More than half these deaths are attributed to opioid-based prescription drugs and other illicit substances, including heroin, according the Centers for Disease Control.

    42 CFR Part 2  presents a major barrier, effectively blocking insurers from informing the prescriber when dangerous combinations of medications are being prescribed to patients  in treatment for substance use disorder.

    The federal confidentiality statute requires that a patient sign multiple written consent forms granting insurers the authority to alert prescribers about medical and/or claims records that indicate a history of drug abuse.

    Certainly, 42 CFR Part 2 was designed to achieve an important and worthy goal—providing a shield of privacy for those struggling with drug and/or alcohol addiction so they would feel more comfortable seeking treatment.

    Protecting the privacy of those seeking help with substance use disorder is still important, but the need for written consent in advance from the patient may prevent important communication between healthcare professionals.

    Take the example of an insurer processing a payment for a long-acting opioid or high quantity of opioid for a patient whose records show recent prescriptions for buprenorphine/naloxone, a medication often used to treat addiction.

    In general, practitioners do not prescribe chronic opioids to a patient who is struggling with substance abuse. Not only does this present a risk for relapse, but could increase the risk of overdose.

    While prescribers control the issuance of opioid prescriptions, all healthcare professionals share a responsibility to ensure their safe and judicious use. It is unrealistic to expect prescribers to address all of the gaps in care given the limited resources and the behavioral health and medical complexities of each patient.

    Next: PDMP, a prescriber resource



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