It was 2009. My wife and I had just moved into a tiny apartment in Maryland, as I began working on my Master’s Degree at St. John’s College. We knew the downstairs neighbors were a bit unhinged from day one: they welcomed our late-night arrival after a cross-country journey by bursting outside and screaming that our going up and down the stairs in the snow was disturbing their slumber. Oh, how I would become familiar with those screams.
Dave and Vicky frequently woke us at 4:30 a.m. with their shouting and throwing things across the downstairs apartment; my newlywed wife and I lay in bed, appalled, unable to sleep, jumping every time we heard a plate hit a wall. We listened through the floor as they fought over who had taken more pills; one day Vicky counted them out, aloud, to prove she hadn’t been using more than her fair share.
Thankfully our stint in Maryland lasted less than a year, but our downstairs neighbors were the canary in the coal mine for what was becoming a national health crisis, though few were talking about it yet: opioid addiction.
To my knowledge, I’ve never used any opioid-based medicine (or narcotic, for that matter), but my wife admits that the Hydrocodone she was prescribed in high school after a foot injury tempted her to seek an unnecessary prescription renewal. She still talks—laughingly—about how good that medicine made her feel. Apparently the stuff is potent.
It’s no wonder, then, that amid a rapidly growing addiction crisis, people begin to feel desperate. It is during feelings of desperation, however, that we often strike deals with the devil (cue the “those who sacrifice liberty for security” quote). And the nearly nationwide Prescription Drug Monitoring Programs that purport to help curb the opioid epidemic are a really bad deal with a really bad devil.
Put in the simplest terms, a PDMP requires anyone who buys prescription drugs to release a mountain of private medical data to a huge list of public and private entities. It is by definition an invasion of individual privacy.
Now, it would be one thing if individual pharmacies were left to decide whether they wanted to share certain information across the medical field. From what we're told, many already do. But when the government starts peeking into my medical files without my consent (or probable cause), that’s not only a violation of privacy, it’s a violation of my constitutionally guaranteed (4th Amendment) freedom from unreasonable searches.
Admirably, much of Lake of the Ozarks is one of the last regions in the country that is not blanketed by a PDMP. Missouri is the only state without a statewide one (Eric Greitens’ onerous attempt at ramming one down Missourians’ throats failed when the legislature refused to fund his executive order). But most of the counties and/or cities in Missouri have opted in to a PDMP administered by St. Louis County. Some municipalities around Lake of the Ozarks have done the same. Miller County embarrassingly jumped on board. But thus far, Camden and Morgan counties have stayed out. So it is that unincorporated areas only under county jurisdiction at Lake of the Ozarks may be the last bastions of medical data privacy in the entire nation.
Well-meaning (but wrong) people of all political stripes argue that PDMPs are an important way to stop opioid abuse. But I ask: if the entire nation (sans small pockets in Missouri) has PDMPs, why is opioid abuse still on the rise? “Well if we didn’t have them, the epidemic would be growing even faster,” is, by the way, an unprovable, illogical, indefensible thing to say.
To add insult to irony, the vastly Republican-controlled Missouri House has approved their version of a PDMP in House Bill 188, an act which could open the door for a federal database—since Missouri would be the final state to enact a PDMP on the state level. Last I checked, Republicans still paid lip-service to small government, states' rights, and (sort of) individual liberty. Representatives like Rocky Miller and David Wood—both of whom I like and respect—vote on behalf of people who don't want more government in their lives or peering in their medicine cabinet. They run on campaigns of less government interference. But then they say things like, "if I have to risk someone finding out that I have a legal prescription that I am using in a legal way in order to find someone that needs help with an addiction then that is worth it." (Wood's comments in a recent newsletter).
Does that not sound creepy to anyone else? We hereby congratulate Mr. Wood on legally using his legal prescriptions, but as recently passed Missouri law reveals, the vicissitudes of "legality" for the kinds of substances with which Missourians can medicate themselves are enough to make a person seasick (or perhaps impart many of the other known side effects of drugs that are currently legal!). What's legal today may be banned tomorrow, and vice versa. So, Mr. Wood, don't pull the "if you're not breaking the law, you have nothing to be afraid of" line with us. Those are ever-shifting sands, and we're not interested in compromising our privacy while trusting the perpetual use of our information to Lord-knows-what federal minions (and corporations that buy access to it). Among Lake-area state reps, Suzie Pollock was the only one who fought for Missourians' 4th Amendment rights in this battle: she voted with 51 others against HB 188. Ninety-five voted for it (three voted present).
You can’t call yourself a limited-government person (or a conservative) if you’re going to push PDMPs. Thank goodness for a handful of reasonable Missouri Senators who have opposed the 2019 PDMP push. But who's to say whether they'll hold the line for the rest of the session?
Now, could PDMPs work? Well, probably a little bit, if all the participating agencies act as they’re supposed to. But, best-case-scenario, prescription monitoring programs would make an insignificant dent in the problem. With doctor-shopping only constituting a tiny percentage of the way opioid abusers get their drugs, does anyone really think that putting an end to doctor-shopping is going to put an end to any statistically significant amount of opioid abuse? Abusers are just going to get the drugs another way.
Meanwhile, law-abiding folks will likely suffer. In the age of massive hacks and data breaches affecting millions of people at a time, a statewide database full of medical information is too alluring a target for hackers to resist. PDMP advocates—including the sponsor of Missouri's bill, Holly Rehder (R-148)—insist the databases will be safe, and that no database has ever been hacked. But according to Politifact, Virginia's prescription drug monitoring database was hacked in 2009. The hack and subsequent ransom note first appeared on Wikileaks, and the FBI has confirmed the PDMP database in Virginia was breached. The Associated Press reported on the story, but to date no arrests have been made.
PDMP proponents think they've found something special: a big government-run program that will work! But it's just the next sequel in the terrible series of prohibition-related laws American governments have attempted. They all fail, spectacularly, and end up accidentally harming vast swaths of citizens.
Here’s what will likely curb opioid abuse more than a PDMP ever could: legalization of medicinal marijuana. When doctors can prescribe non-addictive marijuana in place of horrifically-addictive opioids for pain management, the main gateway to opioid addiction will be closed. In fact, the outlawing of marijuana for the better part of a century is likely what led to the use of far more dangerous drugs for pain treatment. One wonders who benefitted from that little scheme?
I won't end this with the overused "trade liberty for safety" quote by Benjamin Franklin... actually, yes I will.
"Those who would give up essential Liberty, to purchase a little temporary Safety, deserve neither Liberty nor Safety."