Public advocacy group challenges new federal rule that would affect MAT patients

Aug. 29, 2019
Medication-assisted treatment patients could lose patient privacy protection and face potential criminal investigations

On Monday August 26, the Substance Abuse and Mental Health Services Administration (SAMHSA), Department of Health and Human Services (HHS) issued the proposed rule “Confidentiality of Substance Use Disorder Patient Records,” which would eliminate patient confidentiality requirements and expose medication-assisted treatment (MAT) patients to criminal investigations, even when they themselves are not suspected of a crime, said the Drug Policy Alliance.

"We are in the midst of an overdose crisis right now that claimed nearly 70,000 lives in the U.S. alone last year. We need to focus on preventing further deaths by
making it easier, not harder, for people to access medication-assisted treatment," said Lindsay LaSalle, Director of Public Health Law and Policy, Drug Policy Alliance (DPA). "Turning over patient's medical records to law enforcement, even when they are not suspected of a crime, is completely unethical. Steps like this erode trust between patients and providers and may discourage people from seeking care altogether. This is just the latest example of how people who use drugs are criminalized, even when trying to get help."

In its summary, the proposed rule states that “HHS proposes to amend its Confidentiality of Substance Use Disorder Patient Records regulation, to clarify one of the conditions under which a court may authorize disclosure of confidential communications made by a patient to a part 2 program as defined in this regulation. This change will clarify that a court may authorize disclosure of confidential communications when the disclosure is necessary in connection with investigation or prosecution of an extremely serious crime, even if the extremely serious crime was not allegedly committed by the patient."

HHS says it will receive public comment until September 25, 2019. Visit the Federal Register for more information. 

Getting serious about drug overdose prevention

Meanwhile, in recognition of International Overdose Awareness Day (August 31), the Drug Policy Alliance is urging policymakers to adopt bold solutions to the overdose crisis, including innovative harm reduction, drug education, evidence-based treatment and policy solutions in order to make a concerted dent in the overdose crisis, which claimed nearly 70,000 lives in the U.S. alone last year.

“Because people are still dying at an alarming rate, we must be willing to consider alternative approaches such as overdose prevention centers or eliminating criminal penalties for personal drug use that, though proven successful in other countries, may still seem radical,” said LaSalle. “Portugal and Canada were similarly impacted by high overdose mortality and have successfully implemented “outside-the-box” solutions. It’s time for U.S. policymakers to move beyond the rhetoric and get realistic about what it’s going to take to save lives.”

Here is what the organization has proposed:  

Overdose prevention centers: Overdose prevention centers, also known as supervised consumption sites, are a proven approach in reducing drug-related deaths. They offer sterile, controlled settings for people to use pre-obtained drugs under the supervision of trained professionals who can intervene in case of an overdose or other medical event. They also provide healthcare, counseling, and referrals to health and social services, including drug treatment.

Drug checking & safe supply: Recent increases in overdose deaths are driven by synthetic opioids like fentanyl, which are being introduced into the drug supply. Most users don’t appear to be seeking fentanyl and are not aware that their drugs may contain fentanyl. Fentanyl checking strips, originally designed for urine drug tests, are now being used to test for the presence or absence of fentanyl. When people are aware of fentanyl in their drugs, they may choose not to use them, use more slowly, or use with others who have naloxone.

Safety First — a revolutionary drug education program: Telling teens to “Just Say No” to drugs doesn’t work. Unlike D.A.R.E and other abstinence-only programs, DPA’s drug education program, Safety First, is based on the philosophy of harm reduction. It is designed to foster open and honest conversations about drugs and drug-related risks, like overdose, among teens, educators and parents. The program will launch next month.

Low-barrier access to methadone and buprenorphine therapies: Methadone and buprenorphine are medications used to treat opioid addiction. These therapies cut overdose death risk in half. But the stigma associated with drug use has blocked the widespread adoption of life-saving treatment options like these, in addition to policy barriers that make both medications difficult for patients to access.

In the U.S., methadone can only be accessed at federally licensed Opioid Treatment Programs (OTPs) and most patients are required to attend these programs up to six days a week in order to receive their medication. This presents tremendous barriers for people living in rural communities and in areas with limited access to transportation.

Buprenorphine can only be prescribed by doctors and certain other health care providers who have received an advanced training and waiver from the government. Due to these hurdles, the majority of doctors in the U.S. tates have not received this training and cannot prescribe this life-saving medication to their patients.

All drug decriminalization: Each year, there are more than 1.6 million drug arrests in the U.S., most for possession only. DPA supports decriminalizing all drugs, which means no one would face criminal penalties for drug possession or low-level sales.  Decriminalization would prioritize the health and safety of people who use drugs over punishment. It would also reduce the stigma associated with drug use so that more people are encouraged to come out of the shadows and seek treatment and other support.