7.6 Title 42 of the Code of Federal Regulations part 2 (42 CFR part 2)
Title 42 of the Code of Federal Regulations part 2 (42 CFR part 2) particularly interests substance use or dual diagnosis counselors. This was enacted into federal law in 1975 by Congress after they realized the impact of social stigma on substance use and how it deterred people from treatment (SAMHSA, 2008). One fear for people is being prosecuted for the use of illegal substances or associated risky behaviors, which may deter people from treatment (SAMHSA, 2008). 42 CFR part 2 protects the confidentiality of clients seeking substance use treatment or “any individual who has applied for or has been given diagnosis or treatment for a substance use disorder at a federally assisted program” (SAMHSA, 2008). This law protects client information, identifying and records, defined as “any information, recorded or not, relating to a patient received or acquired by a federally assisted alcohol or drug program” (SAMHSA, 2008). The ultimate goal of this ruling was to reduce barriers to substance use treatment and reinforce the confidentiality of clients.
There are exceptions to 42 CFR part 2. Under 42 CFR part 2, client information can be shared with data processing, laboratory analysts, billing, dosage preparation, accounting, and administrative personnel without formal disclosure practices (SAMHSA, 2008). Client information can also be shared within a part 2 program without formal disclosure practices; however, this does not apply between different part 2 programs, which require a client’s written consent as a release of information (SAMHSA, 2008). There are exceptions to any rule, and substance use counselors can disclose necessary client information to needed personnel in the event of a medical or behavioral health emergency, as federal law does not differentiate them (SAMHSA, 2008). While these guidelines may be included under HIPAA, counselors adhere to the most stringent guidelines in moments of discrepancy. To reiterate, the ultimate goal of 42 CFR part 2 is to protect client welfare by improving confidentiality practices and improving access to needed care.
Who Falls Under 42 CFR part 2 Regulations?
42 CFR part 2 language details which facilities are liable for practicing under these guidelines.
Programs that fall under 42 CFR part 2 must meet both of the following criteria (SAMHSA, 2008):
- An individual or entity who provides alcohol and substance use disorder diagnosis, treatment, or referral for treatment AND
- Receives funding from the federal government through any of the following ways:
- Authorized, licensed, or registered by the federal government
- Receives federal funds in any form, even if they do not directly pay for substance use disorder treatment services
- Is assisted by the Internal Revenue Service through a grant of tax-exempt status or allowance of tax deductions for contributions
- If treatment programs are privately funded and do not receive federal funding, they do not fall under 42 CFR part 2 regulations. In these cases, counselors should consult state statutes for added stringency related to providing substance use disorder treatment. Many states have enacted extra protections to protect clients.
- There are a few other ways in which programs can fall under the 42 CFR part 2 criteria. According to SAMHSA (2008), these include:
- Divisions that provide SUD services within a larger entity OR
- Facilities that utilize controlled substances (i.e., benzodiazepines, methadone, suboxone, buprenorphine, etc.) for detoxification care. Use of these substances requires the facility to be registered by the Drug Enforcement Administration (DEA), as this affiliation automatically subjects them to 42 CFR part 2 regulations.