Physician-patient privilege. Doctor-patient confidentiality. HIPPA. There’s a lot that goes into medical confidentiality these days, and the line between what is and isn’t shared is constantly under attack. Since the inception of government-driven healthcare, concern and outright fear about what is (and can be) shared from your medical visits has multiplied. Can you tell your doctor you’re using an illegal substance? Should you? What happens if and after you do?
Doctor-Patient Confidentiality & Illegal Drugs
The biggest fear people face when just thinking about admitting substance use to their doctor is consequences. Discomfort grows when a person is using an illegal substance. The biggest fear is being reported to the authorities. Thanks to doctor-patient confidentiality, this fear is often only as big as you make it. A doctor cannot discuss the information you share in confidence, and if they do, you can take legal recourse, even when admitting something like heroin or cocaine use.
If you choose to talk to your doctor about illegal substance use, you can, in most cases, rest assured that your conversation will remain confidential. You can read up on physician-patient privilege at Wikipedia, but here are the important highlights:
- It’s a Legal Concept: The doctor-patient privilege is a nationally recognized legal concept. It protects what a patient and their doctor discuss from being used against the patient in a court of law, even if the patient confesses to a crime.
- It’s About Help: Physician-patient privilege is built around the idea of building trust. It’s accepted that for a physician to fully treat a patient, the patient must trust the doctor enough to discuss everything, no matter how uncomfortable.
- It Has Limits: The Federal Rules of Evidence (U.S.) does not recognize the physician-patient privilege in criminal matters. At a state level, the concept has limits based on the laws of applicable For example, the state of Texas limits doctor-patient privilege to civil cases and constricts its applicability in criminal proceedings.
- Doctors Must Adhere to Ethics: The Hippocratic Oath has been binding since the 6th Century B.C., but it’s by no means outdated. A modern version exists, and doctors take it. The oath serves as a sort of moral guide, and medical practitioners must abide by a code of ethics. While doctor’s view patient-physician confidentiality as a fundamental tenet of their code of ethics, they are bound to abide by it within the constraints of the law.
- Harm Must be Reported: By law and ethics, a doctor must report severe bodily injury. For example, if a doctor were to fail to report a bullet or gunshot wound, a powder burn, or other injury resulting from the discharge of a gun or firearm, they risk a Class A misdemeanor.
According to Federal Confidentiality Laws, the confidentiality regulations that pertain to drug treatment were first enacted in a concentrated effort to encourage substance abusers to seek help. It was suspected that a substance abuser or addict would be more likely to seek out and enter a treatment program if the details of their use were kept confidential, and this theory has proven true.
When to Discuss Illegal Drug Use With Your Doctor
If you know you have a substance use problem, it’s time to talk to your doctor, even if the drug(s) you’re using are illegal. The point of talking to your doctor is to seek and obtain the kind of treatment that will help you stop abusing drugs and end your addiction.
Your doctor can help you find the right treatment. Your options are not limited, and your physician can connect you with professionals and community resources dedicated to supporting you. From substance abuse counseling programs to prescription support, there have never been more evidence-based options for treating substance abuse and addiction.
Substance Disorders & Medical Insurance
The United States is a minority on the global healthcare scene. Unlike other countries with proven and successful healthcare system, ours is still predominately based on capitalism. The for-profit nature of medical care has resulted in severe inflation of pharmaceuticals and patient care. As a result, roughly 98% of U.S. citizens depend on health insurance because without it medical visits and care would be largely unaffordable.
Healthcare is currently a highly explosive topic. The 2016 presidential election candidates held dramatically different views on it, and the American people are split with strong opinions. The involvement of capitalist insurance companies complicates the system, and based on the recent bill passed by Congress, insurance companies could gain ground for charging policyholders more based on their health conditions, especially preexisting ones.
As of the date of this article, your doctor is required to document your substance abuse history in your medical records. Those records can then be submitted to your insurance agency, and they can then use those records to increase premiums, deny payment, or deny coverage for certain conditions and/or procedures. It is possible that admitting to drug use could affect future coverage when most needed.
For example, a patient tells their doctor they’ve been using heroin once a month for the past year. They seek help and start an appropriate treatment that succeeds in ending their heroin use. 10 to 15 years later, the patient develops a heart condition and requires a heart operation. The patient’s insurance agency can deny coverage of the surgery by stating the patient was documented as using an illegal or controlled substance that is known to cause heart problems when used regularly or long term. This “insurance loophole” doesn’t apply to legal addictive substances, like alcohol and cigarettes.
Should the relationship between substance abuse, addiction, and medical insurance stop you from getting help? No, but it might be something you’ll need to consider based on your circumstances before proceeding cautiously. Medical science has clearly identified substance use disorders as viable medical conditions that are, for many, as unavoidable as diabetes or cancer. Could the manner in which these are treated by insurance companies change in the future? Perhaps, but until then, you’ll need to decide on what’s best for you.
If you’re struggling with an illegal substance use problem, contact a substance abuse professional. They can help you find the right help no matter your circumstances.