Disclosing Substance Use at the ER

Medically Reviewed by Jennifer Casarella, MD on April 22, 2022
4 min read

You’re in the emergency room and the doctor has a question for you: Do you use any drugs? If the answer is yes, should you tell your doctor? Will you get in trouble with the law? Why does your doctor need to know in the first place? Let’s answer those questions and more.

If you’re using any illegal drug such as cocaine, heroin, methamphetamines, and, in some states, marijuana, your doctor needs to know. Also, tell them if you’re using any prescription drugs for which you don’t have a prescription. Prescription drugs that are often misused include stimulant medications used to treat ADHD and prescription painkillers like opioids.

Nearly 12% of American adults said they use drugs in an unhealthy way in a 2018 national survey. Young adults – those 18-25 years old– were the most likely to do so. About 8 million Americans ages 12 and up have misused drugs or have a drug dependence or drug use disorder. And, since we’re talking about the ER, did you know that almost 50 percent of ER visits in the U.S. involve substance use disorders?

The drugs you take have an impact, and not just in the way they make you feel. Your doctor must be able to take these effects into account when diagnosing and treating you. If your doctor doesn’t know what substances you take, that will complicate things. It could even be dangerous to your health.

Here’s an example. What if you start vomiting and can’t stop? That’s worth a trip to the ER. It could be a rare side effect of long-term, regular use of marijuana. But if you don’t tell the ER workers that you use marijuana, they may not be able to diagnose you properly. The condition, called cannabinoid hyperemesis syndrome (CHS), is newly discovered and not yet well understood. For that reason, many doctors may not know to check for it if you don’t clue them in to your drug use.

Or say you have depression and take a selective serotonin reuptake inhibitor (SSRI), a commonly prescribed type of antidepressant. You begin to experience confusion, agitation, a faster than normal heart rate, and other concerning symptoms, so you go to the ER. If you mention that you have also used cocaine or ecstasy, that might help your doctor diagnose serotonin syndrome, which can be fatal if not treated.

If you need emergency surgery, disclosing the drugs you take is critical. Illicit drugs can harm your liver, and that may affect how well your liver processes the anesthesia your doctors use to keep you sedated during your operation. For example, MDMA, also known as ecstasy, can cause all sorts of liver problems, including liver failure. Cocaine and amphetamines can boost your heart rate, your blood pressure, and your body temperature, all of which can complicate surgery.

Those are just a few examples of how illicit substances can complicate your stay in the ER if you’re not upfront with the doctor.

No. Federal law prohibits your doctor from telling the police about your drug use. This law, called the Confidentiality of Substance Use Disorder Patient Records, 42 CFR Part 2, has been in effect since 1975. Lawmakers recognized that if people were afraid of legal trouble, they would be less likely to seek treatment for substance use disorders such as addiction. Though the law has changed somewhat in recent years, its core protections of confidentiality remain.

Confidentiality is a core part of the patient-doctor relationship. ER doctors -- or any doctor, for that matter -- cannot share your medical record without your written permission, except under limited circumstances, including:

  • When needed by other health care providers who are involved in your care
  • When a court order demands that it be turned over to law enforcement
  • When the doctor believes you may harm yourself or others

Doctors who violate your confidentiality will literally pay the price. The fine for sharing medical records inappropriately could be as much as $1.5 million. In some cases, the doctor could go to jail.

No. The only time a car insurance company may request your medical record is if you were injured in an accident and your medical record is needed to verify your injuries.

No. In fact, federal law requires most health plans to offer benefits that cover treatment for substance use disorders just as they do for other medical issues.

No. Your employer does not have access to your medical record. If you missed work due to your trip to the ER, your employer can ask for a note from the doctor that verifies your ER visit. It does not need to include any information on why you went to the ER or what the doctor diagnosed.