There are two sets of laws governing the release of substance abuse information. One requires the patient’s signature for all disclosures, while the other takes a more liberal approach.

The liberal branch is the Health Insurance Portability and Accountability Act (HIPAA), which allows disclosures without the patient’s consent to “covered entities” (eg, doctors, therapists, pharmacists, and insurers who are paying for the patient’s care). The Substance Abuse and Mental Health Services Administration (SAMHSA) has a different take on confidentiality, requiring signed consent before disclosures related to substance use disorders. Most, but not all, psychiatric providers fall under SAMHSA’s umbrella.

Does SAMHSA Govern Your Practice?
SAMHSA law applies to group and individual practices that meet #1 and #2:

1. “Holds itself out” (eg, advertises) as providing treatment or referrals for alcohol or drug abuse


2. Is certified by the federal government or receives federal support, including any of the following:
   
   
   
   • Uses a DEA license to prescribe controlled substances for the treatment of substance use disorders
   
   
   • Receives any federal funding, including Medicare payments, even if the funding is unrelated to the treatment of substance use disorders
   
   
   • Is granted tax exempt status by the IRS
   
   
   
   

On July 13, 2020, SAMHSA modernized the law to allow disclosure without patient consent during emergencies that result from a natural disaster. COVID-19 is included alongside hurricanes and floods in the list, though the opioid crisis is not. Further updates to the law are planned for 2021.