Ethics, Legal Issues, Confidentiality, and Professional Practice
What to know
42 CFR Part 2 provides stricter confidentiality for SUD treatment records than HIPAA; requires written consent for most disclosures, with limited exceptions (medical emergency, court order, suspected child abuse). Know mandatory reporting (child abuse, some infectious diseases), duty to warn/protect (Tarás-off), and informed consent. Understand scope of practice, boundaries, dual relationships, documentation, and ethical principles (autonomy, beneficence, nonmaleficence, justice, fidelity). Know impaired professional reporting and license/credential requirements. Understand drug court and legal intersections, and confidentiality in group settings. Recognize cultural competence and nondiscrimination obligations.
Traps
Questions confuse HIPAA with 42 CFR Part 2 - Part 2 is more protective and requires specific consent language. Watch for items suggesting SUD records can be shared freely with other providers (generally requires consent). Don't confuse duty to warn with mandatory reporting. Note that court orders may compel disclosure but require specific procedures.
Rule of thumb
When in doubt, don't disclose without written consent (or a recognized exception). 42 CFR Part 2 is stricter than HIPAA - apply the stricter rule.
Worked example
A probation officer requests a client's treatment records. Without a valid 42 CFR Part 2-compliant written consent or a court order meeting Part 2 requirements, do not disclose.