October 20, 2014

HIPPA and Opioid Management: Information Can Come In But It Cannot Go Out

Opioids are an important part of pain management.  We, as pain practitioners, provide opioids to allow you to be more active and function better.  Practically, being more active and functioning better means that either you have fewer work restrictions or, if you cannot or do not work, that you are better able to perform your activities of daily living, including being active with your family and in social functions.

Generally, we rely on the patient to tell us how they are doing.  Most of the time, we get a good answer.  Most people are honest.  One of the problems with opioids, however, is that some people abuse them.  Abuse can take many forms, including addiction, with the need to get high; diversion, selling the drugs to get money; or using the opioids to numb, unsuccessfully, psychological issues.  In these cases, people can lie to us.  Indeed, addicts live to lie.

To make sure that people are getting good functional benefit from opioids, we rely on other sources of information, if available.  One of these sources is family members.  My personal experience is that if there is a disagreement within the family as to whether one should be on opioids, then that conflict makes it very difficult to successfully maintain one on opioids.  Therefore, we welcome the input of family members and encourage them to come to office visits so that everyone can understand everyone else’s views and we can decide whether or not opioids are, in fact, the best option.  Sometimes, there is overuse which we are not aware of.   Safety is first.

Some people try to prevent family members from giving their input, stating that HIPPA prevents the family member from talking to us, the provider.  This statement is incorrect.  HIPPA does not prevent us from talking with family members.  HIPPA prevents us from providing privileged health information about you to anyone whom you have not given us the authority to give that information (with some exceptions, such as law enforcement.).  HIPPA does not prevent us from getting information about you from others.   It is a one-way street:  we can listen but we cannot talk.

We want people who receive opioids to have better lives because of the opioids.  If we are not meeting that goal, then we need all the information we can get to find out what needs to be done to work towards the goal of a better life.  In some cases, what needs to be done may be to look at another approach than opioids.  Family members and friends can be an important source of this information and we welcome their input.  Their giving us that input is legal under HIPPA.