The views and opinions expressed herein are those of the author and do not necessarily reflect those of BehaveNet, Inc.


Forget HIPAA for a moment. 42CFR addresses transfer of clinical information about addicts and alcoholics.

According to BTOD REMS, referring to ordering prescriptions for buprenorphine products:

“Each disclosure made with the patient’s written consent must be accompanied by the following written statement:

“This information has been disclosed to you from records protected by Federal confidentiality rules (42 CFR Part 2). The Federal rules prohibit you from making any further disclosure of this information unless further disclosure is expressly permitted by the written consent of the person to whom it pertains or as otherwise permitted by 42 CFR Part 2. A general authorization for the release of medical or other information is NOT sufficient for this purpose. The Federal rules restrict any use of the information to criminally investigate or prosecute any alcohol or drug abuse patient.”

Consultation with a local attorney confirmed this, however some legislator or bureaucrat apparently failed to consider that such communications might involve a modern invention called the telephone. How do you transmit a written notice by phone?

Ordering prescriptions for buprenorphine containing products, whether by phone or electronically, will give away the patient’s opiate addiction diagnosis as soon as I provide my special DEA number. Just ordering a drug FDA approved only for treatment of alcoholism or addiction can give away the diagnosis. Consider naltrexone, disulfiram, varenicline, and acamprosate.

Must prescribers now spout off this notice each time we order a prescription by phone? Will we violate Federal law every time we send an electronic prescription for one of the drugs listed above without including the notice? Must we order those drugs only by fax or paper?

I suggest instead that we relieve prescribers of the duty to inform pharmacists of what they should already know or that SureScripts and other electronic prescribing clearinghouses automatically add the notice to every such order. Nationwide mandatory electronic prescribing of controlled substances would eliminate the need to order buprenorphine by telephone.

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