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Docs can't hide behind HIPAA

November 4, 2011
by Dennis Grantham, Editor-in-Chief
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Use informed consent to end prescription drug abuse

As physicians and behavioral health providers confront the problem of soaring rates of prescription drug abuse and addiction nationwide, they often feel that existing federal regulations involving privacy of health information (HIPAA) and confidentiality (regarding addiction treatment information) can prevent the effective collection and use of patient data about their use of controlled substances—data that could point to abuse or addiction problems.

But that’s definitely not the case, says Ted Parran, MD, a professor of medicine at Case Western Reserve University and GMA Consultants, both of Cleveland, Ohio.

“My opinion is that [physicians have] hidden behind HIPAA and confidentiality rules for too long,” he stated in a recent Addiction Professional webinar. “If I’m seeing a patient in the office and I realize that there’s a probability that the patient, due to chronic pain, significant anxiety, ADHD or other condition, is going to need a long-term prescription for a controlled substance--an opiate, benzo or stimulant—then I’ve got to get out my informed consent form.”

After 25 years in clinical addition treatment, Dr. Parran is quite specific about what this form should contain, as well as how it can be backed by consistent and prudent prescribing policies to protect not only the safety of the patient, but the integrity and interests of the prescriber. He recommends that a discussion preceeding the possible prescribing of a controlled substance should proceed as follows:

“Sit down with the patient and frame your concerns in terms of their safety,” he recommends. “In order for me to safely prescribe a controlled medication, you must give me permission to contact up to three family members or significant others to gather functional data about you. I cannot prescribe this if anything would compromise my ability to contact these people at this time and periodically in the future.”

Perran says that conducting the F-CAGE (Family version of the CAGE questionnaire) with these individuals—what he calls “the single most useful tool for identifying addictive behaviors in a patient—is one critical item in a pre-prescribing assessment.

He adds that the patient’s response to the release of information about family members is also significant. “If the patient demands secrecy and won’t allow the prescriber to contact family members or significant others, than the prescriber’s quid pro quo ought to be ‘Fine, I’ll treat you, but I cannot use a controlled substance unless I have the ability to speak with others and get data about your functioning with this medication.”

Every patient that receives a controlled substance prescription will benefit not only from this informed consent and release-of-information process, says Parran, but also from organization-wide processes that deter, prevent, or identify possible addiction problems with controlled substance prescriptions.

His complete recommendations for establishing prudent prescription policies, identifying possible prescription scams, and ensuring patient safety throughout treatment are available in the complementary Addiction Professional webinar: The Prescription Drug Epidemic: Appropriate Interventions for Addiction Treatment Programs.

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