Balancing Patient Confidentiality and Legal Obligations

EP 03

🎙 Special Series: Advances in Buprenorphine Education

This episode is part of a special series on improving hospital and clinic-based buprenorphine treatment for opioid use disorder.

 

In this episode of ASAM Practice Pearls, Dr. Stephen Holt and Dr. Shawn Cohen welcome addiction medicine expert Dr. Catherine Trimbur. They explore the delicate balance between protecting patient confidentiality and fulfilling legal responsibilities when responding to requests from parole officers, child welfare agencies, and other external entities.

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Host

Stephen Holt, MD, MS, FACP, FASAM

Dr. Stephen Holt has been an attending physician at Yale-New Haven Hospital since 2008 and is an Associate Professor of Medicine at Yale School of Medicine. He is the Director of the Yale Addiction Recovery Clinic and the Associate Program Director for Yale's Primary Care Internal Medicine Residency Program. He is board-certified in Addiction Medicine and Internal Medicine. He has published and lectures frequently on a variety of addiction medicine topics and has won numerous teaching awards at the local, regional, and national levels.

Co-Host

Shawn Cohen, MD

Dr. Shawn Cohen is an addiction medicine doctor at Yale New Haven Hospital. He provides care on a hospital-based addiction consult service and is interested in lowering barriers to MOUD, improving the care of patients experiencing alcohol withdrawal, and making the hospital a more person-centered and less stigmatizing place for people who use substances.

Expert

Catherine Trimbur, MD, MPH

Dr. Catherine Trimbur, triple board-certified in internal medicine, addiction medicine, and palliative care, is an assistant professor at Brown University’s Warren Alpert Medical School. She leads Brown’s Transitions Clinic, providing comprehensive care for formerly incarcerated individuals with serious illnesses and substance use disorders. Dr. Trimbur also offers pain management and palliative care at the Rhode Island Adult Correctional Institute. Committed to medical education, she has developed a curriculum to help residents enhance empathy and reduce stigma in marginalized patient care. She serves on several university and hospital committees related to primary care and health equity.

📖 Show Segments

• 00:03 – Introduction
• 02:15 – Case Scenario: Navigating Parole and Child Welfare Requests
• 03:45 – Differences Between Parole and Probation
• 06:33 – Navigating Parole and Probation in Patient Care
• 09:51 – Advocating for Patients: Effective Communication Strategies
• 13:25 – Advocacy and Education in Interactions with Parole Officers
• 24:09 – Interacting with Child Welfare Systems
• 30:00 – Success Stories and Legislative Impact
• 34:28 – Revisiting the Case Scenario
• 35:56 – Conclusion and Additional Learning Opportunities

📋 Key Takeaways

• Prioritize patient autonomy. Engage patients in decisions regarding information sharing and advocate for their strengths and progress.
• Educate stakeholders. Help parole officers, judges, and other officials understand the medical and psychosocial aspects of addiction treatment to foster more recovery-focused decisions.
• Clarify legal terminology. Understanding distinctions—such as parole (post‑incarceration supervision) versus probation (prison alternative)—helps providers navigate legal complexities more effectively.
• Advocate through documentation. Writing letters to judges and parole officers highlighting patients' progress and health needs can influence decisions, such as waiving fees or avoiding re‑incarceration.
• Leverage patient‑controlled testing. Offering urine toxicology screens under patient control can reduce stress and promote adherence with legal requirements.
• Foster a supportive approach. Encourage family involvement with a focus on support rather than punishment to achieve better long‑term outcomes.
• Address stigma head‑on. Recognize patients' strengths and build trust to improve healthcare experiences and overall engagement.
• Use strategic communication. Employ clear, empathetic, and informed communication with legal and welfare authorities to achieve the best patient outcomes.
• Be persistent in advocacy. Continuous efforts can drive systemic improvements and enhance support structures for justice‑involved patients.
• Push for policy change. Educate legal personnel and support legislative reforms to create a more supportive system for individuals with substance use disorders.

🔗 Resources

• ASAM’s Advanced Buprenorphine Education Series: Explore here.
• Docs for Health: Find additional resources for healthcare providers working with justice-involved patients including letter templates.
• Transitions Clinics: The Transitions Clinic Network is building an innovative healthcare model for individuals returning to the community from incarceration.

📢 Join the Discussion

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