Rehabilitation and the Law: Legal Issue in Addiction Treatment in Ohio

Rehabilitation from addiction is a crucial journey that demands extensive support and careful guidance. However, navigating addiction treatment in Ohio involves more than just medical and therapeutic considerations; it also encompasses a variety of legal issues. The legal landscape surrounding addiction treatment in Ohio shapes the rights and responsibilities of both patients and healthcare providers. 

According to the O’neil Institutes publication of Addiction and Public Policy 2023 State Legislative Roundup In Ohio, recent legislative efforts in 2023 have focused on addressing the opioid crisis and enhancing addiction treatment laws. Legislation passed included oversight of opioid litigation proceeds, expanded access to medications for opioid use disorder (MOUD), and enhanced criminal penalties for fentanyl-related offenses. Additionally, the Ohio Department of Mental Health and Addiction Services has been actively working on comprehensive plans to strengthen the state’s addiction treatment and recovery services workforce​ 

What is Involuntary Commitment to Addiction Treatment in Ohio?

Involuntary commitment to addiction treatment is a legal process through which individuals with substance use disorders can be involuntarily admitted to treatment facilities for their own well-being and safety. According to the Ohio Revised Code, Section 5119.91, a probate court has the authority to order involuntary treatment for individuals experiencing alcohol or other drug abuse. This action is taken based on set procedures outlined in the law, as amended by House Bill 281 in 2023.

This legislation allows for such measures in a bid to manage and treat severe cases of substance abuse where voluntary treatment has not been successful or feasible. It is a mechanism designed to intervene when a person’s substance abuse poses a significant risk to themselves or others, and when voluntary treatment efforts have not been successful or are not feasible.

The process of involuntary commitment typically involves 4 key steps:

• Petition: A concerned individual, such as a family member, friend, or healthcare professional, can file a petition with the court to initiate the involuntary commitment process. The petition outlines the reasons for seeking involuntary treatment and provides evidence of the person’s need for treatment due to their substance abuse.
• Court Evaluation: Once the petition is filed, the court reviews the evidence and may schedule a hearing to evaluate the person’s situation. The court may appoint an evaluator, such as a mental health professional, to assess the individual’s condition and make recommendations.
• Hearing: A hearing is conducted to determine whether involuntary commitment is necessary. The person who is the subject of the petition has the right to legal representation and the opportunity to present their case. The court considers the evidence presented and makes a decision based on the person’s need for treatment and potential risk.
• Treatment Facility Placement: If the court determines that involuntary commitment is warranted, the person is placed in a designated treatment facility for a specified period. The facility must provide appropriate addiction treatment services and care to address the individual’s substance use disorder.

During involuntary commitment, individuals retain certain rights and protections, including the right to receive treatment in the least restrictive environment possible and the right to challenge their commitment through legal processes.

What are the Confidentiality and Privacy Laws in Addiction Treatment in Ohio?

In Ohio, there are confidentiality and privacy laws in place to protect the information and records of individuals receiving addiction treatment. These laws help ensure that individuals can seek treatment without fear of their personal information being disclosed without their consent. Here are some key aspects of confidentiality and privacy laws in addiction treatment in Ohio:

1. Health Insurance Portability and Accountability Act (HIPAA)

The Health Insurance Portability and Accountability Act (HIPAA) safeguarded the privacy of patients across the U.S., establishing a baseline of protection for individuals’ health information managed by healthcare providers, including addiction treatment facilities. HIPAA ensures that personal health information is handled with care, requiring healthcare entities to implement safeguards to protect the confidentiality and security of health data. This includes obtaining patient consent before disclosing any personal health information and setting strict limits on how this data can be used and shared.

In Ohio, HIPAA’s standards are complemented by state-specific legislation that sometimes offers additional privacy protections. This is particularly relevant for individuals with substance use disorders. For instance, Ohio Code 5119.27 enhances privacy provisions comparable to the federal 45 CFR Part 2, which addresses the confidentiality of substance use disorder treatment records specifically. This state-level legislation provides further privacy safeguards, ensuring that the delicate information concerning substance abuse treatment is handled with even greater confidentiality and discretion

2. Confidentiality of Alcohol and Drug Abuse Patient Records (42 CFR Part 2)

The regulation known as 42 CFR Part 2 is a federal policy specifically designed to protect the confidentiality of substance use disorder treatment records. This regulation places strict limitations on the disclosure of such information, tightly controlling how and when patient records can be shared. Under 42 CFR Part 2, patient consent is generally required for any disclosure of treatment information, ensuring that patients have significant control over their personal health information.

According to a 2020 report by the Substance Abuse and Mental Health Services Administration (SAMHSA), revisions to 42 CFR Part 2 were proposed to balance patient privacy with the need for more integrated healthcare services, suggesting a careful consideration of when and how treatment records can be disclosed legally. This is particularly important as stigma and fear of discrimination can deter individuals from accessing needed healthcare services. The regulation’s stringent privacy measures are vital for reducing barriers to treatment and supporting recovery efforts.

3. Consent for Release of Information

In Ohio, the consent for the release of addiction treatment information is strictly regulated to protect patient privacy. Individuals receiving treatment for substance use disorders are required to provide written consent before their treatment information can be disclosed to third parties. This includes sharing information with healthcare providers, family members, or legal entities. The process is governed by specific guidelines that ensure the consent is informed and explicit, detailing the type of information to be disclosed, the purpose of the disclosure, and the identity of the recipient.

The consent form must clearly specify what information can be shared, why it is being shared, and with whom. This consent is also revocable at any time by the patient, adding an additional layer of control for individuals over their personal health information. This regulation is detailed in Ohio Administrative Code 5122-27-06, which stipulates the necessary contents of an authorization for release and emphasizes the protection of patient rights throughout the treatment process.

4. Exceptions to Confidentiality

​​In Ohio, while the confidentiality of addiction treatment information is robustly protected, there are notable exceptions where disclosure without patient consent is permissible under specific circumstances. These exceptions are in place to balance individual privacy with public safety and welfare needs.

• Medical Emergencies: Information can be disclosed during medical emergencies when it is necessary to provide immediate healthcare. In such cases, the healthcare provider may access and disclose necessary medical information without prior patient consent to ensure timely and potentially life-saving treatments.
• Reporting of Child Abuse or Neglect: Healthcare providers are mandated reporters in Ohio. This means they are legally required to report any instances of suspected child abuse or neglect to appropriate authorities. This disclosure is considered essential for the protection of children and overrides confidentiality obligations.
• Court Orders: When a court issues a direct order, healthcare providers may be compelled to release patient information as part of legal proceedings. Such orders usually specify exactly what information is required, ensuring that only the necessary details are disclosed.
• Law Enforcement Requirements: In certain situations, such as when a crime is committed or if there is an immediate risk to public safety, law enforcement officials can request access to patient information without consent. This is usually done under stringent conditions and regulated by specific legal standards to prevent misuse.

5. Substance Abuse Treatment Records in Legal Proceedings

In Ohio, the legal protection of substance use disorder treatment records is stringent, reflecting a strong emphasis on maintaining patient confidentiality even in legal contexts. These records are considered privileged, meaning they cannot be disclosed in legal proceedings without specific authorization. This protection is governed by both federal and state laws, including 42 CFR Part 2 at the federal level and relevant sections of the Ohio Revised Code.

• Written Consent: For treatment records to be disclosed in a legal setting, written consent from the patient is typically required. This consent must be explicit about what information can be disclosed and to whom, ensuring patients retain control over their sensitive information.
• Court Orders: In situations where court involvement is necessary, such as during criminal investigations or custody disputes, a court may issue an order to obtain treatment records. However, obtaining such an order requires demonstrating a compelling need that outweighs the patient’s privacy rights.

What are Ohio’s Statutes on Discrimination and Stigma in Addiction Treatment?

Ohio has established several statutes and regulations to counter discrimination and mitigate stigma associated with addiction treatment. These legal provisions ensure that individuals with substance use disorders are treated equitably and have access to necessary services without facing undue barriers. Here’s a more detailed look at these laws:

Ohio Revised Code (ORC) 3793.28:

This law explicitly prohibits discrimination against individuals based on their status as persons in recovery from a substance use disorder. It ensures that these individuals enjoy the same rights and privileges in areas such as employment, housing, and public accommodations as anyone else. This statute is pivotal in promoting social integration for those in recovery.

Ohio Revised Code (ORC) 3793.29:

This statute focuses on employment and prohibits discrimination against employees or job applicants due to their recovery status. It safeguards equal opportunities for employment, promotions, and other employment-related benefits, thereby supporting individuals in recovery in maintaining and advancing their professional lives.

Ohio Administrative Code (OAC) 5122-26-16:

This rule prevents discrimination in the delivery of mental health and addiction services. It mandates that service providers offer support to individuals with substance use disorders without discrimination, covering various bases such as race, religion, gender, sexual orientation, or disability. This administrative code is crucial for ensuring fair treatment in healthcare settings.

Mental Health Parity and Addiction Equity Act (MHPAEA):

While a federal law, MHPAEA is applicable in Ohio and mandates that health insurance plans offer equal coverage for mental health services and substance use disorder treatments as they do for other medical conditions. This law plays a role in ensuring that those with addiction disorders receive the medical attention they require on par with other health conditions.

These statutes and regulations aim to reduce stigma, promote equal access to treatment, and protect the rights of individuals with substance use disorders. According to the National Institute on Drug Abuse (NIDA), individuals requiring treatment hesitate to seek it due to fears of mistreatment, stereotyping, and societal bias, especially within healthcare environments.

These barriers discourage individuals with substance use disorders from pursuing necessary medical assistance. In fact, a 2021 survey indicated that approximately 10.4% of individuals who felt they needed but did not receive substance use treatment avoided seeking help due to concerns about negative perceptions within their communities. This highlights the significant impact that social stigma can have on the treatment of substance use disorders.

How Do Ohio’s Drug Laws Address Addiction Treatment and Rehabilitation?

​​Ohio’s approach to addiction treatment and rehabilitation is structured around robust legal and ethical frameworks, ensuring that individuals with substance use disorders receive care that respects their autonomy and decision-making capacities. Here are some key considerations, grounded in state laws and guidelines:

1. Capacity to Consent: According to the Ohio Department of Health, legal capacity is defined as the ability of an individual to understand the nature and consequences of a decision, including the benefits, risks, and alternatives to a proposed health care service. For individuals with substance use disorders, capacity assessments may be necessary to ensure they can make informed decisions about their treatment.
2. Informed Consent: The principle of informed consent is central in healthcare, requiring that patients are thoroughly informed about their treatment options. This includes comprehensive information on the nature of the treatment, potential side effects, expected outcomes, and risks involved. The Ohio Department of Health emphasizes the need for clear communication to patients to facilitate informed decisions.
3. Substitute Decision-Makers: In cases where patients cannot make informed decisions, Ohio law allows for the appointment of substitute decision-makers. This can include legally authorized representatives such as guardians or healthcare proxies designated in an advance directive, as outlined by the Ohio Revised Code.
4. Advance Directives and Power of Attorney: Ohio encourages the use of advance directives, such as healthcare powers of attorney and living wills, which allow individuals to express their treatment preferences and designate decision-makers in advance. These legal documents are crucial in instances where a patient’s capacity to make decisions may become compromised, ensuring that their autonomy and prior wishes guide treatment decisions.
5. Court-Ordered Treatment: For individuals who pose a substantial risk to themselves or others and are unable to consent to treatment, the state permits court-ordered treatment. This process, governed by Ohio law, involves a legal hearing where evidence of the individual’s condition and the necessity for treatment are evaluated by a judge, ensuring that involuntary treatment is a last resort and done ethically.

What are the Regulatory Considerations for Medication-Assisted Treatment (MAT)?

In Ohio, there are specific regulatory considerations for Medication-Assisted Treatment (MAT), which is the use of medications in combination with counseling and behavioral therapies for the treatment of substance use disorders. Here are some key regulatory considerations for MAT in Ohio:

• Ohio Department of Mental Health and Addiction Services (OhioMHAS): OhioMHAS is the state agency responsible for overseeing addiction treatment services in Ohio. They establish and enforce regulations related to MAT programs and providers in the state.
• Licensure and Certification: MAT providers in Ohio must be licensed or certified by OhioMHAS to offer addiction treatment services. This includes meeting specific requirements related to staffing, qualifications of healthcare providers, facility standards, and adherence to best practices.
• Accreditation: MAT programs may choose to pursue accreditation from nationally recognized accrediting bodies such as the Commission on Accreditation of Rehabilitation Facilities (CARF) or the Joint Commission. Accreditation demonstrates compliance with industry standards and best practices.
• Medication Dispensing and Storage: MAT providers must comply with regulations regarding the dispensing and storage of medications used in treatment, such as methadone or buprenorphine. This includes proper handling, documentation, and security measures to prevent diversion or misuse of medications.
• DATA 2000 Waiver: Physicians who wish to prescribe buprenorphine for MAT in Ohio must obtain a waiver from the Drug Enforcement Administration (DEA) under the Drug Addiction Treatment Act of 2000 (DATA 2000). To qualify for the waiver, physicians must complete specific training and meet certain requirements.
• Reporting and Monitoring: MAT providers in Ohio are often required to submit reports and data to OhioMHAS or other designated entities for monitoring and quality assurance purposes. This may include data on patient outcomes, medication usage, and compliance with regulations.
• Patient Privacy and Confidentiality: MAT providers in Ohio must adhere to federal and state laws regarding patient privacy and confidentiality, such as HIPAA and Ohio’s laws on the privacy and security of health information. These laws protect the privacy of patient records and impose restrictions on the disclosure of substance use disorder treatment information.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), Medication-Assisted Treatment (MAT) plays an imperative role in combating opioid addiction, one of the most challenging public health issues in Ohio.  MAT accessibility is critical due to the high rates of opioid addiction and related overdoses. SAMHSA reports that in the year ending in November 2020, Ohio experienced a staggering 8,406 drug overdose deaths, emphasizing the urgent need for effective treatment options like MAT. 

Can I be forced into addiction treatment in Ohio?

In certain circumstances, individuals with substance use disorders may be subject to court-ordered treatment in Ohio. If a person poses a substantial risk to themselves or others due to their addiction and cannot make informed decisions, a court may order involuntary treatment.

Can my employer fire me for seeking addiction treatment in Ohio?

In Ohio, employers are generally prohibited from discriminating against employees based on their participation in addiction treatment programs. The Americans with Disabilities Act (ADA) and the Family and Medical Leave Act (FMLA) may provide certain protections for individuals seeking treatment.

Can I file a complaint against a healthcare provider or facility for misconduct in addiction treatment in Ohio?

Yes, individuals who believe they have experienced misconduct or violations of regulations in addiction treatment can file complaints with the Ohio Medical Board, Ohio Board of Nursing, or other relevant licensing boards overseeing healthcare professionals.

Are addiction treatment records protected by privacy laws in Ohio?

Yes, addiction treatment records are protected by federal and state privacy laws, including the Health Insurance Portability and Accountability Act (HIPAA) and Ohio’s laws on health information privacy. These laws restrict the disclosure of sensitive treatment information without the individual’s consent.