House lawmakers have revived debate over the hot-button issue of enhanced privacy for substance use disorder patients. In a Thursday House Energy and Commerce Committee hearing on the opioid epidemic, advocates defended reversing the enhanced privacy policy as critical for providers who need to understand their patients' treatment histories. But opponents blasted the measure as another hurdle for patients who fear seeking addiction treatment because of the stigma involved.
Providers have long advocated for the change, which they hoped would be included in the 21st Century Cures Act. Ultimately the measure, which was sponsored by then-Rep. Tim Murphy (R-Pa.), was dropped.
In a heated exchange, the bill's new sponsor, Rep. Markwayne Mullin (R-Okla.), accused one of the expert witnesses of misleading the panel with overblown testimony.
The witness in question, Dr. Ken Martz, treats patients with addictions and presented lawmakers with some of the unintended consequences of cutting into the heightened HIPAA protections, known as "Part 2" protections under the Public Health Service Act, that bar any sharing of patient records relating to addiction with other providers.
Martz warned that because of the stigma involved with addiction, potential leaking of information could lead to discrimination against the patient when it comes to finding a job or housing, qualifying for loans and more. "The National Survey on Drug Use and Health continues to survey thousands, showing that shame and fear of retribution remain key reasons why people avoid treatment," Martz said. "Their focus should be on their treatment and establishment of recovery not on politics aimed at protecting their right to privacy."
But Mullin noted that it remains illegal for any treatment records to be shared with an employer or landlord, or in a criminal or civil court. Ultimately the question is one of protecting patients from getting prescribed medications they are addicted to, he said.
"Please be a little more factual about what you are saying. We bring you here because you are considered an expert," Mullin told Martz. "You are misleading the panel when you don't include facts."
The debate for-and-against the measure largely broke down along party lines.
Rep. Doris Matsui (D-Calif.) noted that better training of physicians to work with patients on their medical history ought to be considered.
Democrats also pointed to the breaking Facebook data-sharing scandal and the heightened threat of cybersecurity breaches and threats, and how that could hurt patients who already face stigma.
Energy and Commerce ranking member Frank Pallone (D-N.J.) cited a survey that showed more than 50% of emergency department physicians at Johns Hopkins preferred not to treat substance use patients.
Pallone also noted the increased threat of records leaked through cybersecurity breaches that could release the data of a large swath of vulnerable patients, worsening the stigma.
But Rep. Larry Bucshon (R-Ind.) hit back against the idea of physician stigma, saying that as a heart surgeon he saw patients coming to the emergency department to seek narcotics in a legal way.
What is a problem, he said, is treatment of patients who have medical conditions unknown to the physicians, with unforeseen complications caused by medications the doctors were unaware of.
Dr. Eric Strain, director of the Center for Substance Abuse Treatment and Research at Johns Hopkins, testified on behalf of the Mullin bill, noting that even though providers may often know from their patients that they been through addiction treatment, they can still be hamstrung by not knowing what that treatment was.
The enhanced protection is an "artificial" distinction at this point, Strain said.
"I can know patients with substance abuse problems; they've told me, it's in their records. But I still can't get access to treatment records," Strain said.
Along with the debate over the enhanced privacy, lawmakers homed in on expanding the prescription drug monitoring program and streamlining operations across states lines.
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