Opioids

The Costs of Monitoring Your Prescriptions

State databases that track the medications we take invade our privacy without reducing opioid-related deaths.

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Prescription drug monitoring programs do not seem to be very effective at preventing abuse of opioids or other controlled substances. Yet PDMPs amount to a massive invasion of patient privacy, inviting unconstrained government snooping that violates our Fourth Amendment rights.

The number of states with PDMPs tripled between 2001 and 2012, from 16 to 49. These programs are aimed mainly at reducing deaths involving prescription analgesics by preventing "doctor shopping," the practice of obtaining multiple prescriptions from different physicians and filling them at different pharmacies.

But as John Lilly, a family doctor in Springfield, Missouri, notes in the latest issue of the Journal of American Physicians and Surgeons, doctor shopping was never very common, and PDMPs do not seem to have curtailed it. According to the National Survey on Drug Use and Health, the percentage of "nonmedical" users who directly or indirectly obtained opioids through multiple prescriptions rose from 3.6 percent in 2011 to 4.8 percent in 2014.

The survey's questions about prescription drugs changed in 2015, so the numbers for more recent years are not directly comparable. But Lilly calculates that doctor shopping that year accounted for 2.3 percent of prescription opioid "misuse," a rate that fell to 1.7 percent in 2016 before rising to 2.5 percent in 2017.

"Since doctor shopping was the source of only 2.5% of misused pain medicine in 2017," Lilly writes, "it is clear that the problem is not doctor shopping. Even with the entire country under a PDMP, this small percentage is increasing, but 97.5% of the misused opioids will never be identified by a PDMP."

Meanwhile, deaths involving prescription analgesics continued to rise from 2011 through 2017, while deaths involving all opioids—primarily illicitly produced heroin, fentanyl, and fentanyl analogs—more than doubled. PDMPs may have contributed to that trend by deterring analgesic prescriptions and driving nonmedical users, along with some legitimate patients, into the black market, where the drugs are much more dangerous because their potency is highly variable and unpredictable. Several studies have found that PDMPs are associated with increased deaths involving illicit drugs.

The privacy cost of PDMPs is harder to measure but nevertheless undeniable. New Hampshire is currently engaged in a legal battle with the U.S. Drug Enforcement Administration, which asserts the authority to obtain PDMP information through administrative subpoenas rather than the probable-cause warrants required by state law.

Relying on the "third-party doctrine," the DEA argues that it does not need a warrant because examining PDMP records does not qualify as a search under the Fourth Amendment. The U.S. Supreme Court has repeatedly ruled that no warrant is required to obtain information that people voluntarily share with third parties such as banks and phone companies.

But last year the Court declined to extend the third-party doctrine to cellphone location data, noting that such information is collected automatically and "provides an intimate window into a person's life." The American Civil Liberties Union, joined by the New Hampshire Medical Society, argues that the logic of that decision clearly applies to information about the medications people take.

The ACLU notes that patients do not in any meaningful sense consent to the collection of their prescription records. If they seek medical treatment and it involves a prescription drug covered by New Hampshire's PDMP law, that information is automatically added to the database, where it stays for three years.

Furthermore, the ACLU says, a patient's prescription records include highly sensitive information that "can reveal her physician's confidential medical advice, her chosen course of treatment, her diagnosis, and even the stage or severity of her disorder or disease." Letting federal drug warriors peruse those records at will not only compromises patients' privacy; it could have a chilling effect on medical treatment, deterring people from seeking care and confiding in their physicians.

It's debatable whether these burdens would be acceptable even if PDMPs worked as intended. Given their actual track record, the sacrifices they entail are even harder to justify.

© Copyright 2019 by Creators Syndicate Inc.

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  1. Repeal the Controlled Substances Act as there is no federal authority to ban products or services.

    Then Americans can get drugs (that are labeled because Congress can regulate interstate commerce) and make decisions with or without a doctor about ingestion schedules.

    1. This.

      That these information tracking systems do not provide a particular sort of utility is irrelevant. Even if they “saved lives” they would still be a gross affront to liberty.

      But the permissitarians here at Reason apparently don’t look at things that way. Nor do they note that this is all a gross invasion of medical privacy. If abortion cannot be restricted without violating medical privacy just how does any of this fly at all?

    2. You should write a libertarian magazine.

      That we should be free to buy *medicine* to heal ourselves has never occurred to Reason.

      Free to buy pot and heroin, of course, but free to buy simvastatin is just too much anarchy for Reason.

      It’s almost as if they only really care about defending corporate profits.

      1. I have always said prescription laws are the backbone of prohibition.

        And I find it interesting that Reason rarely, if ever, mentions them.

        I will say that all “drugs” are medicines.

        I personally take heroin and xanax.

        Whether it’s beta-blockers, opiates, cholesterol meds, amphetamines, anti-biotics, benzodiazepines, insulin, cocaine, aspirin, tobacco, promethazine, cannabis, prozac, or whatever other medicine you want.

        It should all be available over the counter off the shelf and on Amazon in bulk jars and by the kilo in whatever form you want it.

        This is what a free market in medicine looks like.

        And it’s what the whole world looked like for thousands of years since the beginning of time until 1915 when the Harrison Narcotics Act went into effect.

        Being able to choose your own medicine – whatever that particular substance might be.

        And most importantly – without having to get anybody’s permission to do so – including having to get a government permission slip from a government-sanctioned man-in-a-white-coat or from anyone else.

        Just a free market in medicine – just like a free market in sugar, tomatoes, or anything else.

        Cheers,
        Chris

  2. On the other hand, it does give the socialists more data they can use to subjugate the population.

  3. Without government tracking (and in the future, intervention), medical issues would be the purview of doctors and patients!!!

    We can’t have highly trained medical professionals making decisions without a state-approved course of action put together by a bureaucrat with a public policy degree. The very thought is madness!

  4. “State databases that track the medications we take invade our privacy without reducing opioid-related deaths.”

    Ha ha! That’s cute.

    A “libertarian” site thinks the reason your prescriptions are monitored is to protect you and not to enforce the government enabled rent seeking of the medical mafia.

  5. Wow, how naive must one be to believe the these programs are aimed at preventing drug deaths? A lot more naive than I’ve ever been, that’s for sure.

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