#pdmp

So PDMP is an acronym for Prescription Drug Monitoring Program. PDMPs are essentially statewide electronic databases that monitor the prescribing of controlled substances (generally, all Schedule II to V drugs, so that includes some stimulants, opioids, testosterone, etc. Different states also can designate other drugs of concern, so some states track things like gabapentin or muscle relaxers.) 46 states require prescribers to enroll in and use these programs, and 20 states require pharmacists to enroll.

The exact information collected in the PDMP varies by state, but every state tracks the patient's name and demographic info, the prescribers name, and the medication, dosage, and amount supplied. Some states track things like how the patient paid (cash vs insurance,) ICD codes, and if the person who picked it up is different then the patient.

Users in one state can also access information from other states, so a pharmacist in one state would be able to see prescriptions you've filled in another state.

Cops can gain access to this info if they have a warrant or court order (the exact legal requirements depends on your state.)

this level of surveillance is pretty obviously concerning to me for a lot of fucking reasons and can also cause a lot of practical challenges for people getting their prescriptions filled. i fucking hate PDMPs and I think that any provider who works in a state where it is not mandatory to report to the PDMP should do everything they can not to report and track more data about their patients.

Right, so there’s the PDMP (Prescription Drug Monitoring Program), which is a statewide database of fulfilled prescriptions. 49 states have enacted it, and it’s just poor Missouri which doesn’t.

I’m pretty sure the location that the drug was dispensed from must be noted. Whether the doctor would actually look up this information is a whole ‘nother story.

Since PDMP are statewide, a lot of the nitty gritty details are hammered out by the individual states. Who actually has access to this information falls under this. The access can include doctors, pharmacists, law enforcement,  county coroners, medical examiners, and/or state toxicologists.

I’m not sure if insurance information is logged on the PDMP. According to this, some states do require to input how the prescription was paid for. Some states which do this are Alaska, Arizona, Florida, Illinois, Indiana, Kansas, Kentucky, Massachusetts, Michigan, Nevada, New York, North Dakota, and Oklahoma.

Some interesting sources if you want to do more research:

Drug Enforcement Agency

NAMDSL

Relevant sources: 

Buzzfeed, Huge Government Databases Are Tracking Purchases Of Painkillers, Adderall, And Other Commonly Abused Drugs

Johns Hopkins Bloomberg School of Public Health, The Prescription Opioid Epidemic: An EvidenceBased Approach

Admittedly, Buzzfeed is not my favorite recreational website. A self-identified “social news and entertainment website”, Buzzfeed focuses on the daily creation and curation of contagious content, which it publishes under ‘clickbait’ headlines. (Famous satirical website The Onion actually runs a Buzzfeed parody website, Clickhole: Because all content deserves to go viral.) As Buzzfeed has grown in global popularity, it has started to deliver more than just listicles, quizzes, and videos, with a new focus on more traditional content i.e. breaking news reportage and long-form journalism. 

Leaving its ridiculous title aside, this article (titled The Government Is Probably Tracking Your Painkiller Prescriptions is a good example of higher quality Buzzfeed reportage on an issue that many major news outlets have yet to cover. (Probably because it was written in response to a newsworthy but decidedly drab-sounding report recently published by the Johns Hopkins Bloomberg School of Public Health: The Prescription Opioid Epidemic – An Evidence-Based Approach.) 

At the heart of these two very different pieces is the national epidemic of prescription drug abuse and “pill mills” that has flourished in the US. Prescription opioids such as Percocet, codeine, and OxyContin are highly effective at improving quality of life for the millions of Americans who suffer acute/chronic pain. 

Yet prescription opioids also harbor an extremely high addiction potential. According to the report: "Since 1990 more than 100,000 people in the United States have died — directly or indirectly — from prescribed opioids since prescribing policies changed in the late 1990’s”. This alarming statistic does not even cover other commonly-abused prescription drugs such as benzodiazepines (anti-anxiety meds i.e. Xanax) and amphetamines (ADD medications i.e. Adderall).  

Patient confidentiality is a cornerstone of the American healthcare system, under which 70% of Americans are on at least one prescription drug according to a 2013 MayoClinic study and a national epidemic of “pill mills” and abuse of the aforementioned prescription drugs has flourished. 

As such, the rise of prescription drug monitoring programs (PDMPs) raises a debate that at least 70% of us need to be paying attention to: When do PDMPs cross the line from promoting public health, to encroaching on individual rights to liberty and privacy? I was particularly impressed with the Buzzfeed article for addressing this debate in a well-balanced, informative way.

Some background: Prescription drug monitoring programs are not new to America. The first monitoring program was instituted in 1939; today every state except Missouri has one. 

The Information Age revolutionized PDMPs as much as it did any other aspect of life. The rise of databases (typically for collecting and compiling huge amounts of consumer/security information) has facilitated the rise of PDMPs. Chronologically speaking, the Information Age co-occurred with the beginning of the national opioid epidemic (c. 1990-present).  

It thus makes sense that in 2012, Massachusetts was the first of 23 other states to pass laws requiring doctors to (under certain circumstances) “check patients’ names in databases that track how and where they fill prescriptions for controlled substances.” 

Each state has its own laws and databases, but the basic mechanism is the same: Within a week of dispensing a prescription for controlled substances, pharmacies add the patient’s name and prescription information into the database. When prompted, doctors can comb through the database for patterns (what patients are picking up, how often, from how many different doctors) that suggest patients are either abusing or selling the drugs.  

Evidence suggests and experts agree that increased use/mandating of PDMPs is working. Since Kentucky – often considered the ground zero of the prescription opioid epidemic – mandated PDMP usage, rates of “doctor-shopping” decreased and the number of people seeking addiction treatment increased. The Johns Hopkins report recommends national mandating of PDMPs to curb the drug abuse epidemic that is indeed sweeping our nation. 

However, the “under certain circumstances” clause introduces a whole host of regulatory/privacy issues into the PDMP debate. Points of contention include: (1) Physicians arguing that database entry takes away time from their already-busy schedules; and (2) Concerns about law enforcement’s seemingly unrestricted access to patient-confidential data. 

As of now, law enforcement only needs open investigations – rather than probable cause or even a warrant – to access most states’ databases. While the ACLU successfully sued the DEA in 2014 for accessing Oregon’s prescription drug database without a warrant, this is still quite frightening. 

To quote the Buzzfeed article: “In any health crisis or epidemic, there’s a struggle between public health initiatives to tamp down the epidemic, and people’s individual needs and rights,” [said] Peter Kreiner, the principal investigator at the PDMP Center of Excellence at Brandeis University. 

In my view, the appropriate government bodies – hopefully presided over by President Obama – need to come to a nation-wide consensus on law enforcement access to PDMPs. This consensus would ideally be that law enforcement agencies need warrants, not just open investigations, to go fishing through patients’ confidential information.