Confidentiality during Rapid Drug Detox. Resonable Concern?

Today we had a call from a patient who did not want to give his name or other information while booking his procedure with us.  While we promise utmost confidentiality to all our patients, was he going overboard?  Upon thinking about it, I remembered a letter I answered just a few weeks ago on my MedHelp Addiction Expert Forum and I realized that he was probably right to keep thing super private. We built our own  facility as a free standing clinic, so that no governmental agency has a right to come in and examine our patient charts, like they would have a right to do in a hospital or in a JCAHO  accredited facility.  So, here is the letter I got and my answer. I think you will find it interesting.

My wife is taking 25 10mg Vicodins a day it started with a prescription and then she got hooked. She wants to quit cold turkey but I don't think it would be wise at this point. She is afraid to see a doctor about her problem because she just invested 8 years of her life in college and 2 weeks ago she graduate from Berkeley with a master’s degree and now applying jobs. My question is if she went to the doctor to get help, which she really wants to get off these, will  it be between the doctor and her only or will any future employees be able access this information about her problem? I really or we really need some help with this. I would really appreciate your help.

Thank you.

This was my answer to this gentleman’s letter:
Your wife's concern is, unfortunately, well grounded.  There are certainly very strict HIPAA and privacy regulations as well as simple doctor-patient confidentiality, however as soon as any information hits the insurers, all bets are off.  All insurance companies share their vast information about all of us with each other and all the underwriters, so even though the employers or schools may not find out; if you ever what to buy life/health or other insurance the information will be there. And if it is there for them, who else is it there for?

On the other hand doing this cold turkey is very unwise, as you rightly said.  Your wife will quickly find out that the symptoms of narcotic withdrawal are rather gory and may be intolerable.  One way of attempting it is tapering use slowly and consistently, without breaking a set pattern, i.e. incrementally increasing the time periods between the pills.  Another is switching to a medication like Suboxone and paying out of pocket, again making sure that you are working with a reputable physician and staying the course of consistent tapering of medication.  Many believe that it is easier to taper Suboxone since it is not a pure agonist (opiate), but also a blocker of opioid receptors.

In our practice we see many people who get addicted to Suboxone as well, and turn to us for detox. So please be careful and be persistent in tapering if you choose to go that way.  Another option is to do it with medical assistance like detox under anesthesia.  It is completely confidential, but of course, not covered by insurance.  You can get more info on the web or on my website.  You can also read my blog on the matter.  Good luck to you and your wife and please be in touch, let me know what happens.