Privacy and Digital Health: Causes for Concern and a Way Forward.

Digital health technologies hold promise for addressing substance use disorder (SUD) treatment gaps but also introduce significant privacy risks, challenging patient autonomy and therapeutic trust. This commentary highlights how SUD digital health services, despite claims of "privacy" and "HIPAA compliance," often utilize surveillance technologies that enable widespread data sharing, including sensitive health information and location data, with third parties, often without informed consent. This is particularly concerning as individuals seeking addiction treatment share highly sensitive data that, once outside the controlled medical and research setting, can lead to discrimination, legal risks, and algorithmic profiling. Drawing on evidence of deceptive practices by digital health companies and a lack of oversight, this commentary argues that current approaches prioritize surveillance capitalism over data protection. This model increases vulnerabilities that disproportionately impact marginalized populations. We must reimagine digital health approaches for SUD treatment by rejecting the surveillance-driven status quo. Implementing a "privacy by design" framework is crucial, alongside robust accountability mechanisms and professional guidance. Effective digital health solutions for SUD must be rooted in ethical standards that prioritize patient dignity, autonomy, and privacy as foundational principles, ensuring that technological innovation aligns with established medical and research ethics. Ultimately, the goal is to leverage digital health's potential while safeguarding the rights and well-being of vulnerable individuals seeking SUD treatment.