Associate Professor of Sociology at Saint Louis University, Liz Chiarello, argues that new drug surveillance programs called Prescription Drug Monitoring Programs (PDMPs) blur the lines between law enforcement and health care.
In her recently published book, "Policing Patients: Treatment and Surveillance on the Frontlines of the Opioid Crisis," Chiarello discusses instances of patients being denied care and doctors being prosecuted for overprescribing pain medications.
PDMPs were put in place as one solution in response to the growing number of opioid-related deaths in the United States.
A PDMP is a database that tracks prescriptions of controlled substances, like morphine or oxycodone. These programs were made to document and flag doctors who overprescribe opioids to patients and identify patients who visit several doctors to obtain new prescriptions. Law enforcement agents, prosecutors, physicians, and pharmacists all have access to this database and medical information. This brings up questions about privacy, says Chiarello, and whether or not access to this information goes against the privacy rights of the individual or the patient.
[The PDMP], "undermines the way that we usually think that medicine should work and the privacy protections that are associated with our health data," says Chiarello.
PDMPs do not only affect patients. They flag physicians too.
"If doctors violate the stipulations under which they're allowed to provide these controlled medications, then they're extremely vulnerable because you go from being a doctor in the eyes of the law to being a drug dealer in the eyes of the law," Chiarello says.
Physicians can face arrest, prosecution, and even jail time if law enforcement notices a pattern of overprescribing opioids to their patients.
So, what happens when a patient with suspicious opioid-use history goes to the pharmacy to request a new prescription?
Chiarello says a pharmacist might say, "Well, I looked you up in the database and the database shows me that you just went to two different doctors in the last month. And so, this is too soon for me to dispense this to you."
Chiarello says this direct communication from the pharmacist, "says to the patient, I'm looking at you. And I have data about what you've been doing when you're not at my pharmacy. But then it also tells them, you're not really welcome back here. Like, don't come back to me because I'm surveilling you."
The goal of these programs is to deter people from overusing opioids, and therefore lessen the impact of the opioid crisis. However, people who use opioids, larger amounts that might be flagged by a PDMP, are not all opioid abusers. For example, there are patients with chronic pain who have been living with a certain prescription that allows them to function normally in their daily lives. Without it, they would be living in constant pain.
Chiarello dives deeper into the topic of PDMPs and how these programs impact patients with chronic pain and the future of drug prescription regulation in a conversation with Maiken Scott, host of The Pulse.
Doctors have had to figure out how to rework their practice to navigate a shifting legal territory. And so what a lot of doctors have done is they just refused to provide opioids. And they feel like that protects them, but it doesn't necessarily protect their patients. So this is a space where the ethics of medicine and the care for the patient bump up against the fear of law enforcement.