The Costs of Monitoring Your Prescriptions

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

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