SAMHSA Proposes Changes to Addiction Treatment Privacy Rules

The federal Substance Abuse and Mental Health Services Administration (SAMHSA) has proposed changes to the rules that govern substance use disorder (SUD) treatment records. The goal is to loosen certain restrictions in an effort to better coordinate patient care, especially for those being treated for opioid addiction.

Specifically, the proposed rule, which was announced in August, targets several sections of 42 CFR part 2.

“These provisions will be an important part of the federal response to the opioid epidemic, while maintaining part 2 confidentiality protections,” according to a federal fact sheet on the proposal.


Currently, 42 CFR part 2 prohibits providers from disclosing patients’ SUD treatment records except in limited circumstances. SAMHSA’s proposed rule would make those circumstances slightly less limited.

For example, it would allow a patient to consent to the disclosure of SUD records to any entity without having to name a specific recipient, and it would exempt non-SUD treatment providers from 42 CFR part 2 privacy rules except under special circumstances.

On top of that, the changes would add natural disasters that disrupt treatment to the list of “bona fide medical emergencies” that permit providers to share SUD records without patient consent. Plus, under the rule, disclosures for the purpose of “payment and health care operations” would be allowed with written patient consent.


In an effort to prevent duplicate SUD enrollment, the rule also proposes the creation of a state prescription drug monitoring program (PDMP). Opioid treatment programs (OTP) would be permitted to enroll in the registry and report data when prescribing or dispensing medications. Non-OPT providers would also be able to query the central registry.

Other changes the rule would introduce include: revisions to the standard for court ordered disclosures; clarifications on the scope of disclosures allowed for audits and evaluation; and changes to disclosure rules related to research.

Finally, the proposed rule would extend court-ordered placement of an undercover agent or informant within a 42 CFR part 2 program to a period of 12 months, with that period subject to extension with court authorization.

You can read a full list of the proposed changes here.

Despite the changes, many of the basics of 42 CFR part 2 would remain the same under the proposed rule. For example, the rule would maintain current restrictions on using SUD patient records in criminal prosecutions. It would also continue to prohibit the disclosure of records without patient consent.

SAMHSA is accepting public comments on the proposed rule through October 24.