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Big Data and the Opioid Crisis: Balancing Patient Privacy with Public Health

Published online by Cambridge University Press:  01 January 2021

Extract

Parts I through III of this paper will examine several, increasingly comprehensive forms of aggregation, ranging from insurance reimbursement “lock-in” programs to PDMPs to completely unified electronic medical records (EMRs). Each part will advocate for the adoption of these aggregation systems and provide suggestions for effective implementation in the fight against opioid misuse. All PDMPs are not made equal, however, and Part II will, therefore, focus on several elements — mandating prescriber usage, streamlining the user interface, ensuring timely data uploads, creating a national data repository, mitigating privacy concerns, and training doctors on how to respond to perceived doctor-shopping — that can make these systems more effective. In each part, we will also discuss the privacy concerns of aggregating data, ranging from minimal to significant, and highlight the unique role of stigma in motivating these concerns. In Part IV, we will conclude by suggesting remedial steps to offset this loss of privacy and to combat the stigma around SUDs and mental health disorders in general.

Type
Symposium Articles
Copyright
Copyright © American Society of Law, Medicine and Ethics 2018

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References

For example, see Google’s life sciences spinoff, Verily. Verily, Verily Projects, available at <https://verily.com/projects/> (last visited February 22, 2018) (“We are developing tools and platforms to enable more continuous health data collection for timely decision-making and effective interventions. We are running longitudinal studies to better understand ways to predict and prevent disease onset and progression. And, we are undertaking significant joint efforts with partners to radically transform the way healthcare is delivered.”).+(last+visited+February+22,+2018)+(“We+are+developing+tools+and+platforms+to+enable+more+continuous+health+data+collection+for+timely+decision-making+and+effective+interventions.+We+are+running+longitudinal+studies+to+better+understand+ways+to+predict+and+prevent+disease+onset+and+progression.+And,+we+are+undertaking+significant+joint+efforts+with+partners+to+radically+transform+the+way+healthcare+is+delivered.”).>Google Scholar
See, e.g., Frakt, A., “A Helpful Tool to Combat the Opioid Crisis,” New York Times, September 11, 2017, available at <https://www.nytimes.com/2017/09/11/upshot/a-helpful-tool-to-combat-the-opioid-crisis.html?_r=0> (last visited February 22, 2018) (“That’s where prescription drug monitoring programs come in. They collect data from pharmacies to track what prescriptions for controlled substances patients have filled. The databases can be used to assess whether patients are getting more opioids than they can safely use. In addition, they can be used to tell if patients are getting other drugs, like a benzodiazepine, that are dangerous to use in combination with an opioid.”).+(last+visited+February+22,+2018)+(“That’s+where+prescription+drug+monitoring+programs+come+in.+They+collect+data+from+pharmacies+to+track+what+prescriptions+for+controlled+substances+patients+have+filled.+The+databases+can+be+used+to+assess+whether+patients+are+getting+more+opioids+than+they+can+safely+use.+In+addition,+they+can+be+used+to+tell+if+patients+are+getting+other+drugs,+like+a+benzodiazepine,+that+are+dangerous+to+use+in+combination+with+an+opioid.”).>Google Scholar
Prescription Drug Monitoring Program Training and Technical Assistance Center, PDMP Mandatory Query by Prescribers and Dispensers (2018), available at <http://www.pdmpassist.org/pdf/Mandatory_Query_20180102.pdf> (last visited February 22, 2018). Of these thirty-nine states, fourteen require that both prescribers and dispensers consult the PDMPs. Id.+(last+visited+February+22,+2018).+Of+these+thirty-nine+states,+fourteen+require+that+both+prescribers+and+dispensers+consult+the+PDMPs.+Id.>Google Scholar
Prescription Drug Monitoring Act of 2017, H.R. 1854, 115th Cong. § 3 (2017) (“[E]ach covered state shall require … each prescribing practitioner within the covered State … to consult the PDMP of the covered State before initiating treatment with a prescription for a controlled substance listed in schedule II, III, or IV [of the Controlled Substances Act].”). The Controlled Substances Act categorizes substances based upon their accepted medical usefulness, their relative potential for abuse, and risk of creating physical or psychological dependence. Schedule II substances have a high potential for abuse and risk of physical and psychological dependence and include hydromorphone (Dilaudid), oxycodone (OxyContin), amphetamines (Dexedrine and Adderall), and methylpheni-date (Ritalin). Schedule III substances have a moderate to low chance of physical dependence or high chance of psychological dependence and include narcotics including less than 15 milligrams of hydrocodone per dosage unit (Vicodin), buprenorphine (Suboxone), ketamine, benzphetamine (Didrex), and anabolic steroids. Schedule IV substances have a low potential for abuse relative to higher schedules and include alprazolam (Xanax), clonazepam (Klonopin), lorazepam (Ativan), and triazolam (Halcion).Google Scholar
Center for Medicaid & CHIP Services, Centers for Medicare & Medicaid Services, Medicaid Drug Utilization Review State Comparison/Summary Report (2017), available at <https://www.medicaid.gov/medicaid-chip-program-information/by-topics/prescription-drugs/downloads/2016-dur-summary-report.pdf> (last accessed February 22, 2018).+(last+accessed+February+22,+2018).>Google Scholar
Humphreys, K., “How Insurance Companies Can Help Fight the Opioid Epidemic,” Washington Post, September 25, 2017, available at <https://www.washingtonpost.com/news/wonk/wp/2017/09/25/how-insurance-companies-can-help-fight-the-opioid-epidemic/> (last visited February 22, 2018).+(last+visited+February+22,+2018).>Google Scholar
McDonald, D.C. and Carlson, K.E., “Estimating the Prevalence of Opioid Diversion by ‘Doctor Shoppers’ in the United States,” PLOSone 8, no. 7 (2013): 111.Google Scholar
Contract Year 2019 Policy and Technical Changes to the Medicare Advantage, Medicare Cost Plan, Medicare Fee-for-Service, the Medicare Prescription Drug Benefit Programs, and the PACE Program, 82 Fed. Reg. 56336 (November 28, 2017).Google Scholar
Roberts, A.W. et al., “Controlled Substance Lock-In Programs: Examining an Unintended Consequence of a Prescription Drug Abuse Policy,” Health Affairs 35, no. 10 (2016): 18841892, at 1887.CrossRefGoogle Scholar
See Werle, N. and Zedillo, E., “We Can’t Go Cold Turkey: Why Suppressing Drug Markets Endangers Society,” Journal of Law, Medicine & Ethics 46, no. 2 (2018): 325-342.Google Scholar
See Roberts, supra note 9, at 1888.Google Scholar
See, e.g., Skinner, A.C. et al., “Reducing Opioid Misuse: Evaluation of a Medicaid Controlled Substance Lock-In Program,” 17 The Journal of Pain 17, no. 11 (2016): 11501155, at 1154 (“Our findings suggest that although [“lock-in” programs] might reduce costs, there may be unintended consequences. Assessing the full effect of such programs is essential to ensuring patients receive needed care. Additionally, further research on the effect of programs designed to reduce prescription opioid misuse on the concurrent increase in heroin use and overdose is warranted because of the recent secondary epidemic of heroin use and overdose and the widespread reporting by heroin users their opioid use was initiated with prescription opioids. Research on the extent to which Medicaid Lock-In Program restrictions affect or trigger illicit opioid use could include urine toxicological screening data on patients, behavioral interviews, and/or a more complete assessment of dispensed prescription medications using prescription drug monitoring program data.” (internal citations omitted)).CrossRefGoogle Scholar
Office of the Attorney General, California Department of Justice, Prescription Drug Monitoring Program, available at <https://oag.ca.gov/sites/all/files/agweb/pdfs/pdmp/brochure.pdf> (last visited on February 22, 2018).+(last+visited+on+February+22,+2018).>Google Scholar
Buchmueller, T. C. and Carey, C., “The Effect of Prescription Drug Monitoring Programs on Opioid Utilization in Medicare,” National Bureau of Economic Research, No. w23148 (2017).Google Scholar
Lydgate, J., Assistant Attorney General of Massachusetts, remarks to “Law and the Opioid Crisis” seminar at Yale Law School, New Haven, Connecticut, October 2, 2017. See also Massachusetts Department of Public Health, The MA Prescription Monitoring Program: A Report to the Massachusetts Legislature (2013), at 7, available at <http://archives.lib.state.ma.us/bitstream/handle/2452/625940/ocn974922509.pdf> (last visited on May 31, 2018) (“[I]t is strictly prohibited to use the MA Online PMP as part of routine inspections, for general screening, or any other manner not in support of an already open and ongoing investigation.”).+(last+visited+on+May+31,+2018)+(“[I]t+is+strictly+prohibited+to+use+the+MA+Online+PMP+as+part+of+routine+inspections,+for+general+screening,+or+any+other+manner+not+in+support+of+an+already+open+and+ongoing+investigation.”).>Google Scholar
Delcher, C. et al., “Abrupt Decline in Oxycodone-Caused Mortality after Implementation of Florida’s Prescription Drug Monitoring Program,” Drug and Alcohol Dependence 150 (2015): 6368, at 63.Google Scholar
Id. at 64.Google Scholar
Id. at 65.Google Scholar
Id. (“[T]here is evidence that health care providers accessed Florida’s PDMP at a rapid rate after implementation. We calculated that Kentucky’s PDMP, widely used as a national model, averaged only 84 queries per health care provider four years after their PDMP went online. Florida’s PDMP surpassed that rate (92 queries per health care provider) four months after implementation. Third, health care providers are known to make medical (as opposed to legal) decisions and change their prescribing habits when they have access to PDMP information.” (internal citations omitted)).Google Scholar
Sauber-Schatz, E.K. et al., “Associations Between Pain Clinic Density and Distributions of Opioid Pain Relievers, Drug-Related Deaths, Hospitalizations, Emergency Department Visits, and Neonatal Abstinence Syndrome in Florida,” Drug and Alcohol Dependence 133, no. 1 (2013): 161166, at 161 (“Pill mills have multiplied in Florida since 2007, where in some counties they are reportedly more numerous than common fast food chain restaurants.” (internal citations omitted)).Google Scholar
Id. at 65-66. Still, the highest rate of closures for pain management clinics came in August 2011 — two months before the creation of the PDMP — likely as a result of HB7095, which had passed the prior month. Id. at 65.Google Scholar
Surratt, H.L. et al., “Reductions in Prescription Opioid Diversion Following Recent Legislative Interventions in Florida,” Pharmacopediology and Drug Safety 23, no. 3 (2014): 314320.Google Scholar
Buchmueller and Carey, supra note 15; Meara, E. et al., “State Legal Restrictions and Prescription-Opioid Use among Disabled Adults,” New England Journal of Medicine 375, no. 1 (2016): 4453; L.J. Paulozzi et al., “Prescription Drug Monitoring Programs and Death Rates from Drug Overdose,” Pain Medicine 12, no. 5 (2011): 747–754; L.M. Reifler et al., “Do Prescription Monitoring Programs Impact State Trends in Opioid Abuse/Misuse?” Pain Medicine 13, no. 3 (2012): 434–442; A.B. Jena et al., “Opioid Prescribing by Multiple Providers in Medicare: Retrospective Observational Study of Insurance Claims,” British Medical Journal 348 (2014); G. Li et al., “Prescription Drug Monitoring and Drug Overdose Mortality”’ Injury Epidemiology 1, no. 1 (2014), 1–8; J.E. Brady et al., “Prescription Drug Monitoring and Dispensing of Prescription Opioids,” Public Health Reports 129, no. 2 (2014): 139–147; T.M. Haegerich et al., “What We Know, and Don’t Know, About the Impact of State Policy and Systems-Level Interventions on Prescription Drug Overdose,” Drug and Alcohol Dependence 145 (2014): 34–47. See also I. Ayres and A. Jalal, “The Impact of Prescription Drug Monitoring Programs on U.S. Opioid Prescriptions,” Journal of Law, Medicine & Ethics 46, no. 2 (2018): 387-403.CrossRefGoogle Scholar
Buchmueller and Carey, supra note 15.Google Scholar
Delcher, C. et al., “Trends in Florida’s Prescription Drug Monitoring Program Registration and Utilization: Implications for Increasing Voluntary Use,” Journal of Opioid Management 13, no. 5 (2017): 283-289.CrossRefGoogle Scholar
Rutkow, L. et al., “Effect of Florida’s Prescription Drug Monitoring Program and Pill Mill Laws on Opioid Prescribing and Use,” JAMA Internal Medicine 175, no. 10 (2015): 1642-1649.Google Scholar
Buchmueller and Carey, supra note 15, at 2-3 (“[W]e find that implementing a ‘must access’ PDMP reduces many of measures of excessive quantity — the share of beneficiaries obtaining more than seven months supply in each half-year, and the share that fill claims before the previous claim’s days supply has been used. In addition, we find that ‘must access’ PDMPs reduce ‘shopping’ behavior. In treatment states relative to controls, the percentage of Medicare Part D enrollees who obtain prescriptions from five or more prescribers falls by 8% and the percentage of enrollees who obtain prescriptions from five or more pharmacies by more than 15%. These results suggest that measures that require prescribers to access the PDMP can be an effective way to reduce questionable opioid use patterns.”).Google Scholar
Patrick, S.W. et al., “Implementation of Prescription Drug Monitoring Programs Associated with Reductions in Opioid-Related Death Rates,” Health Affairs 35, no. 7 (2016): 13241332.CrossRefGoogle Scholar
Urahn, S.K. at al., “Prescription Drug Monitoring Programs, Evidence-Based Practices to Optimize Prescriber Use,” Pew Charitable Trusts, December 2016, at 9, available at <http://www.pewtrusts.org/~/media/assets/2016/12/prescription_drug_monitoring_programs.pdf> (last visited February 22, 2018).+(last+visited+February+22,+2018).>Google Scholar
Office of Missouri Governor Eric Greitens, Governor Eric Greitens Announces Statewide Prescription Drug Monitoring Program, July 17, 2017, available at <https://governor.mo.gov/news/archive/governor-eric-greitens-announces-statewide-prescription-drug-monitoring-program> (last visited on February 22, 2018).+(last+visited+on+February+22,+2018).>Google Scholar
CT Gen. Stat. § 21a-408d (2012).Google Scholar
Baehren, D.F. et al., “A Statewide Prescription Monitoring Program Affects Emergency Department Prescribing Behaviors,” Annals of Emergency Medicine 56, no. 1 (2010): 1923; T.C. Green et al., “How Does Use of a Prescription Monitoring Program Change Medical Practice?” Pain Medicine 12, no. 10 (2012): 1314–1323.Google Scholar
Delcher, supra note 17, at 65.Google Scholar
Urahn, supra note 32, at 8–9.Google Scholar
National Alliance for Model State Drug Laws, Mandated Use of Prescription Drug Monitoring Programs, June 30, 2017, at 2, available at <http://www.namsdl.org/library/FE179822-E782-AA56-9E97D5E5D9F19D7B> (last visited on February 22, 2018).+(last+visited+on+February+22,+2018).>Google Scholar
See Ayres and Jalal, supra note 25.Google Scholar
Freeman, P.R. et al., Kentucky House Bill 1 Impact Evaluation: Executive Summary, The Kentucky Cabinet for Health and Family Services 2 (March 2015), at 2, available at <http://www.chfs.ky.gov/NR/rdonlyres/842D66B1-612C-4A26-9FE2-C526329D0BEE/0/KentuckyHB1ImpactStudyExecutiveSummary03262015.pdf> (last visited on February 22, 2018).+(last+visited+on+February+22,+2018).>Google Scholar
Center for Disease Control and Prevention, Opioid Overdose: State Successes, October 5, 2017, available at <https://www.cdc.gov/drugoverdose/policy/successes.html> (last visited on February 22, 2018).+(last+visited+on+February+22,+2018).>Google Scholar
Id. (“In interviews and surveys of prescribers, pharmacists and law enforcement when asked about their experience with HB1 and its implementation stated that although there was initial confusion and disruptions to workflow in their professions those have largely been resolved and, for the most part, have not negatively impacted health care professional practices. It should be noted however, that a minority of prescribers indicated they no longer prescribe CS, or prescribe fewer CS, as a result of the HB1 mandate and its burden on their practices.”).Google Scholar
Urahn, supra note 32, at 12.Google Scholar
See § I.b infra.Google Scholar
Urahn, supra note 32, at 34-35. One bright note in this effort is that, according to the Pew Charitable Trusts report out of the Heller School at Brandeis University, 81.3% of states already have some form of streamlined prescriber enrollment process. Id. at 25 Fig. 9.Google Scholar
Id. at 15, 31.Google Scholar
Office of Public Affairs, Department of Justice, Office of Justice Programs Announces Grant Awards of More Than $8.8 Million to Help Reduce Prescription Drug Abuse, Misuse, Diversion (2016), available at <https://www.justice.gov/opa/pr/office-justice-programs-announces-grant-awards-more-88-million-help-reduce-prescription-drug> (last visited on February 22, 2018).+(last+visited+on+February+22,+2018).>Google Scholar
Prescription Drug Monitoring Act of 2017, H.R. 1854, 115th Cong. (2017).Google Scholar
See, e.g., Mattina, Christina, “OxyContin Maker Purdue to Fund Upgrade of Virginia Prescription Monitoring System,” The American Journal of Managed Care, January 29, 2017, available at <http://www.ajmc.com/newsroom/oxycontin-maker-purdue-to-fund-upgrade-of-virginia-prescription-monitoring-system> (last visited on February 24, 2018).+(last+visited+on+February+24,+2018).>Google Scholar
But see Guevremont, N., Barnes, M., and Haupt, C.E., “Physician Autonomy and the Opioid Crisis,” Journal of Law, Medicine & Ethics 46, no. 2 (2018): 203-219 (describing mandatory consultation of a PDMP as a “[r]egulatory response … within the normal [medical] disciplinary processes”).Google Scholar
The President’s Commission on Combating Drug Addiction and the Opioid Crisis, Final Report, November 1, 2017, at 54, available at <https://www.whitehouse.gov/sites/whitehouse.gov/files/images/Final_Report_Draft_11-15-2017_0.pdf> (last visited on February 22, 2018).+(last+visited+on+February+22,+2018).>Google Scholar
Hildebran, C., “How Clinicians Use Prescription Drug Monitoring Programs: A Qualitative Inquiry,” Pain Medicine 15 (2014): 11791186, at 1184 tbl. 3 (outlining recommendations by surveyed physicians for ways of increasing PDMP use).CrossRefGoogle Scholar
Urahn, supra note 32, at 47.Google Scholar
Id. at 29.Google Scholar
Id. at 30 Fig. 7.Google Scholar
“Developing a Five-Year Roadmap: A Roundtable on Optimizing State PDMPs from 2015 to 2020,” roundtable discussion at The Pew Charitable Trusts and Bureau of Justice Assistance, Atlanta, GA, April 6, 2015.Google Scholar
Id. at 34.Google Scholar
See Ayres and Jalal, supra note 25.Google Scholar
Patrick, supra note 30, at 1329.Google Scholar
Simoni-Wastila, L., “We Need a National Prescription Drug Monitoring Program,” New York Times, February 16, 2012, available at <https://www.nytimes.com/roomfordebate/2012/02/15/how-to-curb-prescription-drug-abuse/we-need-a-national-prescription-drug-monitoring-program> (last accessed February 22, 2018) (“A national Prescription Drug Monitoring Program will provide uniform expectations of appropriate use that affects all players — prescribers, dispensers and consumers. As well, a national program will relieve the growing onus on states without such programs that find their backyards filled with diverters fleeing states that have them. A national P.D.M.P. would bring much-needed standards for data collection, analyses, outcomes and evaluation. The most important reason for implementing a national P.D.M.P., however, … is the potential to bring prescription drug abusers into treatment.”).+(last+accessed+February+22,+2018)+(“A+national+Prescription+Drug+Monitoring+Program+will+provide+uniform+expectations+of+appropriate+use+that+affects+all+players+—+prescribers,+dispensers+and+consumers.+As+well,+a+national+program+will+relieve+the+growing+onus+on+states+without+such+programs+that+find+their+backyards+filled+with+diverters+fleeing+states+that+have+them.+A+national+P.D.M.P.+would+bring+much-needed+standards+for+data+collection,+analyses,+outcomes+and+evaluation.+The+most+important+reason+for+implementing+a+national+P.D.M.P.,+however,+…+is+the+potential+to+bring+prescription+drug+abusers+into+treatment.”).>Google Scholar
Appriss, Health, North Carolina Joins PMP Interconnect Interstate PDMP Data Sharing Platform to Help Address Opioid Epidemic (2018), available at <https://apprisshealth.com/press-release/north-carolina-joins-pmp-interconnect-interstate-pdmp-data-sharing-platform-help-address-opioid-epidemic/> (last visited on February 22, 2018).+(last+visited+on+February+22,+2018).>Google Scholar
Health Strategy Group, The Aspen Institute, Confronting Our Nation’s Opioid Crisis: A Report of the Aspen Health Strategy Group 1-2 (Weil, Alan R. & Dolan, Rachel eds. 2017).Google Scholar
Id. at 15.Google Scholar
Urahn, supra note 32, at 5 (“Twenty PDMPs allow law enforcement to query the database pursuant to active investigations, while 30 require a court order, subpoena, search warrant, or grand jury order.”).Google Scholar
The National Governors Association has also identified interoperability as a key feature of their “road map” for addressing the opioid crisis. National Governors Association, Finding Solutions to the Prescription Opioid and Heroin Crisis: A Road Map for States (2016), at 19, available at <https://www.nga.org/files/live/sites/NGA/files/pdf/2016/1607NGAOpioidRoadMap.pdf> (last visited on February 22, 2018).+(last+visited+on+February+22,+2018).>Google Scholar
Kam, D., “Proposed Changes to Florida Prescription Drug Database under Fire,” Palm Beach Post, August 27, 2013, available at <http://www.palmbeachpost.com/news/state--regional-govt--politics/proposed-changes-florida-prescription-drug-database-under-fire/leKRgFBEik3jg5rhHpaNBP/> (last visited on February 22, 2018).+(last+visited+on+February+22,+2018).>Google Scholar
Modifications to the HIPAA Privacy, Security, Enforcement, and Breach Notification Rules under the Health Information Technology for Economic and Clinical Health Act and the Genetic Information Nondiscrimination Act; Other Modifications to the HIPAA Rules, 78 Fed. Reg. 5566 (January 25, 2013).Google Scholar
Urahn, supra note 32, at 5.Google Scholar
Office of the Attorney General, Prescription Drug Monitoring Program, supra note 14; Simoni-Wastila, supra note 67.Google Scholar
Lydgate, supra note 16.Google Scholar
W. Va. Code § 60A-9-5 (2017) (“The information required by this article to be kept by the Board of Pharmacy is confidential and … is open to inspection only by inspectors and agents of the Board of Pharmacy, members of the West Virginia State Police expressly authorized by the Superintendent of the West Virginia State Police to have access to the information, authorized agents of local law-enforcement agencies as members of a federally affiliated drug task force, authorized agents of the federal Drug Enforcement Administration … .”).Google Scholar
Guevremont, Barnes, and Haupt, supra note 52.Google Scholar
Pardo, B., “Do More Robust Prescription Drug Monitoring Programs Reduce Prescription Opioid Overdose?” Addiction 112, no. 10 (2016): 17731783.Google Scholar
Id. at 1780-1781.Google Scholar
Id. at 1781.Google Scholar
For a popular recent account of such “pill mills,” see Quinones, S., Dreamland: The True Tale of America’s Opiate Epidemic (New York: Bloomsbury Press, 2015): at 156160.Google Scholar
Lembke, A., Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop (Baltimore, MD: Johns Hopkins University Press, 2016): at 126.Google Scholar
42 C.F.R. §2.12(a).Google Scholar
42 C.F.R. §2.12(b)(2).Google Scholar
42 C.F.R. § 2.12(e)(1) (“Coverage includes, but is not limited to, those treatment or rehabilitation programs, employee assistance programs, programs within general hospitals, school-based programs, and private practitioners who hold themselves out as providing, and provide substance use disorder diagnosis, treatment, or referral for treatment. However, the regulations in this part would not apply, for example, to emergency room personnel who refer a patient to the intensive care unit for an apparent overdose, unless the primary function of such personnel is the provision of substance use disorder diagnosis, treatment, or referral for treatment and they are identified as providing such services or the emergency room has promoted itself to the community as a provider of such services.”).Google Scholar
Substance Abuse and Mental Health Services Association, Substance Abuse Confidentiality Regulations (2017), available at <https://www.samhsa.gov/about-us/who-we-are/laws-regulations/confidentiality-regulations-faqs> (last visited on February 22, 2018).+(last+visited+on+February+22,+2018).>Google Scholar
42 C.F.R. § 2.31(a) (“A written consent to a disclosure under the regulations in this part may be paper or electronic and must include:...The specific name(s) or general designation(s) of the part 2 program(s), entity(ies), or individual(s) permitted to make the disclosure.”).Google Scholar
42 C.F.R. § 2.13(d).Google Scholar
See Confidentiality of Substance Use Disorder Patient Records, 82 Fed. Reg. 6087 (Jan. 18, 2017) (“The types of information that might be requested include diagnostic information, medications and dosages, lab tests, allergies, substance use history summaries, trauma history summary, employment information, living situation and social supports, and claims/encounter data. However, the entity creating the consent form may provide options to include free text space, or choices based on a generally accepted architecture or document such as the C–CDA, or Summary of Care Record, as defined by CMS for the EHR Incentive Program.”). But see i.e. (“It is permissible to include ‘all my substance use disorder information’ as long as more granular options are also included. If options are provided, it is also permissible to provide check boxes next to each option. The designation of the ‘Amount and Kind’ of information to be disclosed must have sufficient specificity to allow the disclosing program or other entity to comply with the request.”).Google Scholar
Protecting Jessica Grubb’s Legacy Act, S. 1850, 115th Cong. (2017).Google Scholar
45 C.F.R. § 164.512(b)(1)(i).Google Scholar
Kohn, L.T. et al., eds., To Err is Human: Building a Safer Health System (Washington, D.C.: The National Academies Press, 2000): at 1.Google Scholar
Legal Action Center, Campaign to Protect Patient Privacy Rights (2017), available at <https://lac.org/wp-content/uploads/2017/09/CPPart2-Principles-.pdf> (last visited on February 22, 2018).+(last+visited+on+February+22,+2018).>Google Scholar
National Alliance on Mental Illness, NAMI Policy Priorities and Comprehensive Mental Health Reform Legislation (2016), at 7, available at <http://www.namikenosha.org/uploads/4/9/0/6/49066629/nami_policy_priorities_and_comprehensive_mh_reform.pdf> (last visited on February 22, 2018) (“NAMI strongly supports inclusion of language that repeals 42 CFR Part 2, federal regulations restricting the disclosure of individual’s alcohol and drug records. NAMI believes HIPAA provides sufficient patient protections and that this separate regulation creates barriers to integration of care and improved health outcomes for people living with cooccurring mental health and substance use disorders.”).+(last+visited+on+February+22,+2018)+(“NAMI+strongly+supports+inclusion+of+language+that+repeals+42+CFR+Part+2,+federal+regulations+restricting+the+disclosure+of+individual’s+alcohol+and+drug+records.+NAMI+believes+HIPAA+provides+sufficient+patient+protections+and+that+this+separate+regulation+creates+barriers+to+integration+of+care+and+improved+health+outcomes+for+people+living+with+cooccurring+mental+health+and+substance+use+disorders.”).>Google Scholar
See Garey, J., “When Doctors Discriminate,” New York Times, August 10, 2013, available at <http://www.nytimes.com/2013/08/11/opinion/sunday/when-doctors-discriminate.html> (last accessed February 22, 2018).+(last+accessed+February+22,+2018).>Google Scholar
42 C.F.R. § 2.12 (“These regulations do not apply to information on substance use disorder patients maintained in connection with the Department of Veterans Affairs’ provision of hospital care, nursing home care, domiciliary care, and medical services under Title 38, U.S.C. Those records are governed by 38 U.S.C. 7332 and regulations issued under that authority by the Secretary of Veterans Affairs.”).Google Scholar
Human Rights Watch, No Time to Waste: Evidence-Based Treatment for Drug Dependence at the United States Veterans Administration Department of Veterans Affairs, June 30, 2014, available at <https://www.hrw.org/report/2014/06/30/no-time-waste/evidence-based-treatment-drug-dependence-united-states-veterans> (last visited on February 24, 2018) (“The VHA has made progress in ensuring access, particularly with increasing use of office-based buprenorphine, and veterans in VHA care have greater access to these medications than do non-veterans in the community.”).+(last+visited+on+February+24,+2018)+(“The+VHA+has+made+progress+in+ensuring+access,+particularly+with+increasing+use+of+office-based+buprenorphine,+and+veterans+in+VHA+care+have+greater+access+to+these+medications+than+do+non-veterans+in+the+community.”).>Google Scholar
Mehta, N. et al., “Evidence for Effective Interventions to Reduce Mental Health-Related Stigma and Discrimination in the Medium and Long Term: Systematic Review,” British Journal of Psychiatry 207, no. 5 (2015): 377384.Google Scholar