A surveillance tool pioneered by law enforcement is now at work in doctor’s offices and pharmacies across Missouri. Prescription drug monitoring programs are intended to combat the opioid crisis and increase efficiency in pharmacies.
However, the author of a recent study argues that the programs have a darker side.
“There is one thing that prescription drug monitoring programs are really good at, and that is bringing down prescribing rates,” said Liz Chiarello, associate professor of sociology and anthropology at St. Louis University. “But overdose is through the roof.”
Chiarello explored the ways that PDMPs fail to curb rates of addiction and overdose deaths in her latest paper, published in the American Sociological Review in November.
In cases where a PDMP flags an individual for being at risk for an overdose, she said, a pharmacist’s best option is to turn that patient away.
“That's not health care; that's refusal,” she said. “If pharmacists were offering patients more resources, saying, ‘Look, I can't give you this, but I can initiate you on buprenorphine or I can give you methadone today,’ that would be a really different situation. But that's not where we are.” (Buprenorphine and methadone are medicines used to treat opioid use disorder.)
“We're at a place where pharmacists use a surveillance technology to refuse to provide care to the patient,” Chiarello added, “or in some extreme cases, to call law enforcement and encourage them to target the patient.”
In her paper, Chiarello also explores the ways that PDMPs, which she refers to as “Trojan horse technologies,” threaten the level of privacy that patients expect in health care settings.
“We usually think about the Trojan horse metaphor as a way of describing smuggling something harmful in the guise of a gift, and prescription drug monitoring programs were essentially a gift from law enforcement to health care,” she said. “They're a way of giving law enforcement access to data that they normally don't have access to, which is information in the electronic health record, which is protected by HIPAA.”
For more on prescription drug monitoring programs, and the consequences of their use in pharmacies, listen to St. Louis on the Air on Apple Podcast, Spotify or Google Podcast, or by clicking the play button below.
“St. Louis on the Air” brings you the stories of St. Louis and the people who live, work and create in our region. The show is produced by Miya Norfleet, Emily Woodbury, Danny Wicentowski, Elaine Cha and Alex Heuer. Roshae Hemmings is our production assistant. The audio engineer is Aaron Doerr. Send questions and comments about this story to talk@stlpr.org.
