As HIPAA changes loom,patients demand continued confidentiality for SUD records

In last week's issue, we wrote about the plans by the federal Department of Health and Human Services (HHS) to weaken the Health Insurance Portability and Accountability Act (HIPAA), citing regulatory burdens and the need for information‐sharing (see ADAW, Jan. 21). The plans, detailed in a request for information (RFI) issued Dec. 12, throw a wrench into the plans by the “make 42 CFR Part 2 like HIPAA” movement, which would erase the federal confidentiality regulation protecting substance use disorder (SUD) treatment records by watering it down to HIPAA standards. Now, with even HIPAA seeming too burdensome, the need is even greater to protect the consent provision of 42 CFR Part 2 — which is basically all that's left after the Substance Abuse and Mental Health Services Administration (SAMHSA) allowed information‐sharing for the vague “health care operations” without consent last year (see ADAW, Jan. 8, 2018). Last week, H. Westley Clark, M.D., J.D., dean's executive professor at Santa Clara University and former director of the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration, made this abundantly clear in his comments to ADAW.     

ADA settlement exposes liability when providers refuse MAT patients

Gov. Andrew Cuomo of New York has added opioid use disorders (OUDs) to the list of approved conditions for which medical marijuana could be prescribed in the state, following the lead last month of New Jersey Gov. Phil Murphy, who limited such use as an “adjunct” to medications like methadone and buprenorphine (see ADAW, Jan. 28).     

Sublocade trial data published: Better than placebo

Sublocade, a buprenorphine injection that lasts a month, was approved by the Food and Drug Administration (FDA) for the treatment of opioid use disorder more than a year ago (see ADAW, Dec. 11, 2017), but the data that led to the approval was not public. It was made public in an article by Sublocade manufacturer Indivior published Feb. 18 in The Lancet.     

Alcoholism starts in youth,so it should be screened for

Alcohol use disorder (AUD) — what used to be called alcoholism, but a condition which by definition is sometimes used to apply to everyone who drinks alcohol and is underage — is not a disease of adults only. It starts in childhood, and that's why Scott E. Hadland, M.D., and colleagues argue for screening in the February issue of Pediatrics.     

Cannabis found more harmful to cognition than alcohol in teens

Lasting effects of adolescent cannabis use are even more pronounced than those for alcohol, researchers suggest in a new study of the role of impaired cognition on substance use. According to the study, published in the February issue of the American Journal of Psychiatry, both alcohol and cannabis misuse are related to impaired cognition, but is this cause or correlation? To infer cause, researchers in general use four theoretical models.     

‘Cash‐only’ buprenorphine a threat to opioid crisis

In an editorial written by the principal researcher on the clinical trials that led to the approval of buprenorphine‐naloxone to treat opioid use disorder, the increase in cash‐only buprenorphine clinics is called a threat to the opioid treatment system. “Proliferation of Cash‐Only Buprenorphine Treatment Clinics: A Threat to the Nation's Response to the Opioid Crisis,” by Art Van Zee, M.D., of the St. Charles Clinic, Stone Mountain Health Services, and David Fiellin, M.D., of the Yale University School of Medicine, was published in the March issue of the American Journal of Public Health.     

Senate Appropriations Committee hears about funding needs for SAPT block grant

The opioid epidemic is persisting, calling for the need for more funding, according to testimony on Capitol Hill last month. Mark Stringer, director of the Missouri Department of Mental Health and single state authority (SSA) for the state's Substance Abuse Prevention and Treatment (SAPT) block grant. In addition, it's important to transition from opioid‐focused funding to general funding for substance use prevention and treatment in general, via increasing the block grant, he said.     

Stop Stigma Now plans for future

Stop Stigma Now is planning to combine the names of NDRI‐USA and Stop Stigma Now, in a move that the organization hopes will give it more gravitas. Stop Stigma Now is a growing force in the methadone treatment patient community, which has been eclipsed by the general move to buprenorphine and naltrexone in media coverage.     

Philadelphia‐based harm‐reduction advocate joins CleanSlate

Brooke Feldman is well‐known to the Philadelphia world of drug users as a peer counselor active in harm‐reduction work. But starting this week, she will be Center Manager for two sites owned by CleanSlate Centers, a treatment program focused on opioid and alcohol addiction. Feldman has a master's in social work and is able to bridge the “street” world and that of the established treatment center—but acknowledges that there was a leap of faith involved in joining the treatment field.     

OTPs look toward criminal justice as major area for growth

Opioid treatment programs (OTPs), formerly known as methadone clinics, were set for a dramatic expansion several years ago when the opioid crisis was growing at an increasing rate, but now, that expansion is targeted toward one population of patients in particular: those in the criminal justice system. In particular, people who are in prison and jail are most likely to need — and not receive — treatment for opioid use disorder (OUD), and the nation's OTPs are ready to help.