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Medication-Assisted Treatment and Confidentiality

Most people are relieved to know that when they participate in medication-assisted treatment (MAT), their privacy is protected by strict federal guidelines. People who work in substance abuse treatment centers work with regulations that are stricter than the ones that protect your regular medical records. The guidelines that protect you in medication-assisted treatment are always referred to as 42 CFR Part 2. The guidelines that come into play in your family doctor’s office are called HIPAA.

42 CFR Part 2 (let’s call it 42 CFR) stands for the forty-second chapter in the Code of Federal Regulations, and Part 2 specifically addresses not just your treatment but also the protection of your treatment records. HIPAA refers to the 1996 Health Insurance Portability and Accountability Act, which was initially passed to designate who could or could not have access to your health records, but it also sets strict rules for protecting your information so that unintended persons cannot see it.

Addiction treatment professionals are subject to severe penalties if they violate 42 CFR, up to and including loss of their professional license. At the very least, if your information is accidentally disclosed to another person, the compliance officer at the medication-assisted treatment program must complete a form for the secretary of disclosure at the government’s Department of Health and Human Services (HHS). The form must indicate how the information was disclosed and whether or not the patient can be identified; the person to whom it was accidentally disclosed; whether or not the person actually viewed the disclosed information; and the extent of the risk to your protected health information. You can see that violations of 42 CFR are taken very seriously at medication-assisted treatment centers.

How 42 CFR Works at Medication-Assisted Treatment Centers

Years ago, medication-assisted treatment centers were very different. The person came to a methadone office—often located in a dreary building down the hill from the administrative offices—got their medication, and left. Today’s medication-assisted treatment centers offer therapeutic counseling intended to motivate the clients by helping them to look at their own lives and figure out what they would like to change. There is a professional licensed counselor assigned to each client, and that person then helps the client find the agencies that will help them expand opportunities in their lives.

The old 42 CFR regulations would often stand in the way of that communication. Even if an individual was referred by the courts, the first document that needed to be signed was an authorization permitting exchange of information between staff at the medication-assisted treatment program and the staff from the judge’s office.

Here are just a few examples of how seriously 42 CFR is regarded in order to protect the confidentiality of people in treatment:

  • In 2010, during the federal government’s census, a census taker went to a residential treatment center to count the people who were staying there in treatment. That was the place where they were sleeping and receiving mail for 180 days, and it had to be counted as their temporary home. The case manager introduced each of the persons to the census taker as “Client Number One” and so forth. It was then up to the client to decide whether they wanted to provide the census taker with personal information—or not.
  • A man was referred by the courts and he signed an authorization permitting his medication-assisted treatment counselor to exchange information with his probation officer. A week or so later he told that treatment counselor that he was revoking the authorization. The treatment counselor was completely bound by his words and could no longer communicate with the probation officer—he could not even tell the probation officer that the authorization had been revoked. Now, that did not work out so well for the man in treatment. When the probation officer could no longer get information about his client’s progress, he had the client arrested and threatened incarceration. The client decided it would be better to sign a new authorization.
  • You may have experienced this yourself: On your first day to the medication-assisted treatment program, your brother-in-law drops you off at the front door of the program. You are inside for quite a while, and the brother-in-law finally goes through the door and asks the receptionist how much longer you’ll be. “I can’t even tell you if that person is here,” the receptionist says. As crazy as it seems, that’s the law.
  • If your boss suspects that you have a problem with addiction and calls the clinic, the counselor would tell them they didn’t know anyone by your name. They would then discuss it with you and if you wanted to sign an authorization, they would then tell the boss only that you were receiving social services at that location. The counselor would then help you develop responses for your boss so that you could protect your own privacy.

The people who work in treatment generally refer to these authorizations as “releases,” and so when they talk to you about signing releases, they mean the authorizations.

Your Right to Privacy

It is important that you are aware that all of the employees at a medication-assisted treatment program function under very strict guidelines of confidentiality. Today’s electronic records can track someone’s access to your electronic chart. The recent revision of 42 CFR now authorizes all of the departments within one program or clinic to have access to a client’s electronic record, assuming you have signed the agency’s general authorization form.

However, you can rest assured that most clinics are very protective of access. So if the receptionist at the medication dispensing window, for example, has opened the Physical Exam portion of your chart, it would be detectable and the receptionist would need to have a good reason for looking into that area of your chart. Since many medication-assisted treatment programs offer doctors and specialists that can help you get medical care, it’s a good idea to participate in as many activities as you can while you’re in treatment there, knowing that your privacy is protected no matter what.

Many people dealing with addiction issues put off getting into treatment because they don’t want their family, their neighbors, or their boss to know they are receiving methadone. Rest assured that the staff at your community medication-assisted treatment program will maintain full confidentiality of your treatment and care. They take your privacy and protection of your records very seriously! Don’t let fear of disclosure be the thing that stops you from getting the help you need.



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