A client at Clinic 461 in Woodstock recently had her addiction recovery records supeoned against her wishes by the local Children's Aid Society in that region.

The following affidavit was submitted in support of her right to privacy of record and in accordance with the stated policies of Clinic 461 in regards to the communication of our toxicology records.

The arguments made by the Canadian Medical Protective Agency in regards to this case were successful in protecting this client's right to privacy of her addiction recovery records.

Affidavit Submitted:

I am a medical doctor duly licensed to practice medicine in the Province of Ontario. I have completed training in psychiatry, have worked as a psychiatrist in various capacities, and have previously held appointment as an Associate Professor of Psychiatry at the University of Western Ontario.

I have published extensively on issues relating to mental health and have completed post-graduate training in Consultation and Acute Care Psychiatry. I am currently Associate Director of Clinic 528, a program of Methadone Maintenance Treatment (“MMT”) serving eight hundred patients in treatment for opiate drug addiction in London, Ontario.

I have participated in the medical treatment of over eight hundred patients suffering from addictions of different kinds. I am responsible for the implementation of administrative policies and clinical working procedures at Clinic 528 in London. I work as a physician in Clinic 528 and have a private office of Methadone Maintenance Treatment in which two hundred patients are enrolled.

I facilitate two Recovery Support Groups weekly for persons in methadone treatment and recovering from opiate drug addiction. I am the author of Handbook of Recovery – A Guide for Clients of Methadone Maintenance Treatment, their Families, Friends and Caregivers.

I was one of two medical doctors and three pharmacists who founded Clinic 461 (the “Clinic”) in Woodstock, Ontario. I am no longer formally associated with the Clinic, nor do I have any financial or professional interest in it.

As a result of my expertise and experience, I have knowledge of the matters set out below. Where I have relied on information from others, I have identified the source of my information and I believe the information to be true.

I am advised by Dr. Don M. Fuller that he has been asked to provide medical records pertaining to a patient in his MMT program to the Children’s Aid Society, even though the patient has revoked her consent to have those records released.

He advised me that he provided the Children’s Aid Society in this matter with a summary of the patient’s progress, her degree of motivation, and her continued participation in the Clinic’s treatment plan. I understand that the Children’s Aid Society has requested more complete disclosure of the patient’s records, including toxicology test results.

The Importance of Confidentiality in the Addiction Treatment Setting

Opiate addiction involves a driving need to obtain narcotic drugs. This drive will steadily increase and take precedence over other life priorities and responsibilities. Methadone Maintenance Treatment provides relief from this driving force and will thus give patients an opportunity to regain a lifestyle balance and make appropriate priorities.

Issues of privacy and confidentiality are of fundamental importance to the treatment of persons with opiate and other drug addiction. For successful treatment, it is necessary to establish a supportive environment in which patients can seek medical assistance for their addictions without fear of reprisals.

This environment permits patients to feel secure, to engage in treatment and to honestly participate in a therapeutic alliance with the medical team. It builds and reinforces trust, which can be essential for successful recovery. In my experience, without assurance of confidentiality, patients in need either do not attend for treatment or discontinue treatment before they are well.

At the Clinic, patients sign agreement that clinical findings and toxicology results will be voluntarily collected with the sole purpose of facilitating their recovery from drug addiction. A blank copy of this agreement is attached.

I drafted the Interpretation of Urine Toxicology Testing Statement of Policy (the “policy”) for Clinic 461. This policy is still in effect at the Clinic. A copy of the policy is attached.

As indicated in the policy, urine toxicology is conducted only for clinical purposes of facilitating recovery from drug addiction. The testing conducted by the Clinic is not used for monitoring or other purposes of outside agencies or third parties.

Providing assurances of confidentiality permits doctors at the Clinic to establish a level of trust with their patients that would be undermined if medical records are routinely disclosed to third party agencies for purposes that have nothing to do with supporting the recovery process.

Participation in treatment is undermined if patients know that the testing may be involuntarily used for outside monitoring purposes. I have personally discussed this issue with patients who are reluctant to participate in testing for fear of outside involvement or access to test results. If patients are reluctant to participate in testing, they are less likely to participate in treatment or, alternatively, are provided reason to manipulate the integrity of the testing process.

I have been personally involved in several patient care circumstances where the use of clinical toxicology results for the purposes of outside monitoring has led to negative complications of treatment and/or to the discontinuation of treatment entirely.

The Clinic and other similar treatment centres depend on voluntary motivation on the part of those in substance treatment programs. Disclosing these records to third parties will discourage those suffering from opiate or other addictions to seek the help they require.

Urine Testing in the Clinic’s Treatment of Patients

In addition, toxicology samples in the Clinic setting are not collected in a manner consistent with the standard requirements of abstinence monitoring programs. This represents a further reason for limiting their use and disclosure. Clinic procedures rely on twice weekly interview assessments of recovery progress.

Urine toxicology results are interpreted in the context of these assessments and over an extended period of time. The test results are not taken at face value and are instead one factor in an approach to treatment that looks at various sources of information.

In a clinical setting, doctors control for this lower degree of reliability by interpreting test results in tandem with the clinical findings they make during frequent patient interview.

As such, it is entirely possible that a patient with periodic positive toxicology results may be assessed as progressing very well in their personal recovery from addiction while another patient with negative toxicology results may be assessed as less reliable or clinically unstable.

It is for this reason that we are always willing to provide a written summary opinion of any client’s progress in treatment, but that we resist providing individual test results that may be interpreted without consideration of their means of collection or clinical context and with unwarranted implications.

Taken outside of their clinical context, urine test results collected in these conditions may be misleading and may not accurately indicate the degree of progress in recovery or the motivation of an individual client.

In short, the urine testing conducted at the Clinic are not collected with a sufficient degree of reliability for forensic purposes. Samples are not collected in observed settings, nor are they sealed and tracked with a degree of care that one would associate with forensic science.

It is well known to those of us who work in this setting that the reliability of urine testing at the Clinic may be particularly compromised under those circumstances when the results are requested for the purposes of non-clinical monitoring. In my experience, this circumstance may substantially complicate a patient’s treatment and may lessen or prolong the likelihood of addiction recovery.

I make this affidavit in response to the motion materials filed by the Children’s Aid Society of Oxford County in this matter and for no other or improper purpose.