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How Govt. Crack Downs on Drug Prescriptions Can Backfire Spectacularly and Kill Privacy

Efforts to crack down on pills threaten privacy and may cause addicts to turn to heroin.

If you get a prescription for Vicodin or Valium, Xanax or OxyContin, it almost certainly gets recorded in a government database. Almost every state now has a “prescription drug monitoring program" (PDMP), a registry listing every patient who was prescribed a drug scheduled in the federal Controlled Substances Act. According to the National Alliance for Model State Drug Laws, a federally funded nonprofit group that designs drug laws and urges states to enact them, 43 states have such programs, most established in the last decade, and six more are in the process of setting them up. The only exceptions are Missouri and Washington, DC. 

Who gets access to that information varies from state to state, but it’s generally available to government health and licensing agencies, law enforcement, pharmacists, and doctors. Most programs send reports out when a patient gets more drugs than they deem likely for legitimate medical purposes. These reports are typically generated when someone obtains a prescription for a controlled substance from more than four to six doctors or fills one at more than four to six pharmacies within a 30-day period. Thirty states are authorized to provide such unsolicited reports to law enforcement.

Supporters of the programs say they are essential to fight the abuse of prescription drugs like OxyContin, which has risen dramatically since the late 1990s. Critics say they are ineffective, jeopardize patients’ privacy, and intimidate doctors who are trying to treat people in severe pain.

“The available evidence suggests that PDMPs are effective in reducing the time required for drug diversion investigations, changing prescribing behavior, reducing ‘doctor shopping,’ and reducing prescription drug abuse,” said a report issued in January by the Congressional Research Service. But it also said that there was limited research on the programs’ effectiveness, and that their unintended consequences might include “limiting access to medications for legitimate use or pushing drug diversion activities over the border into a neighboring state.” 

“There is a risk of deterring patients with legitimate medical needs, and more seriously, a deterrent to doctors,” says Nathan Wessler, an American Civil Liberties Union staff lawyer representing four patients and one doctor in a suit challenging the Drug Enforcement Administration’s access to Oregon’s database. He believes the programs’ privacy provisions are too weak to protect patients.

The Popularity of Prescription Drugs

Prescription drugs, including opioid painkillers like OxyContin and Vicodin, tranquilizers like Xanax and Valium, and stimulants like Adderall, are the nation’s second most popular kind of illegal intoxicant. In 2011, the federal Substance Abuse and Mental Health Services Administration’s annual National Survey on Drug Use and Health estimated that 6.1 million Americans had used prescription drugs to get high in the last month. That was far behind marijuana, which had 18.1 million monthly users, but well ahead of cocaine, which had less than 1.5 million, and hallucinogens, methamphetamine and heroin, all under 1 million. (As these figures are based on responses to a government survey, they may be low, but the proportions roughly parallel the quantities seized by the Drug Enforcement Administration.)

More people die from overdoses of prescription drugs than from illegal drugs such as heroin, according to the federal Centers for Disease Control’s statistics. Of the 38,000 people who fatally overdosed in 2010, the CDC found, prescription drugs were a cause in 22,000, with opioids involved in about three-fourths of those deaths. The 36,000 overdose deaths in 2008 showed a similar pattern. On the other hand, according to the CDC figures, more than half the people listed as dying from prescription drugs had mixed them with other drugs such as heroin, cocaine or alcohol, and one-sixth were suicides.

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