The Controlled Substances Prescription Monitoring Program was established by an act of the legislature, and went into effect this past December. It joins Arizona with 37 other states that have or are planning similar monitoring programs. The text of the law is rather brief, creating "a computerized central database tracking system to track the prescribing, dispensing and consumption of schedule II, III and IV controlled substances" for the purposes of assisting "law enforcement to identify illegal activity" and to "[p]rovide information to patients, medical practitioners and pharmacists to help avoid the inappropriate use of schedule II, III and IV controlled substances."
Well, isn't that nice and helpful.
The rules (PDF) created by the Arizona State Board of Pharmacy are more detailed. Of particular interest, the rules allow access to the database to:
- A person who is authorized to prescribe or dispense a controlled substance to assist that person to provide medical or pharmaceutical care to a patient or to evaluate a patient;
- An individual who requests the individual's own controlled substance prescription information under A.R.S. § 12-2293;
- A professional licensing board established under A.R.S. Title 32, Chapter 7, 11, 13, 14, 15, 16, 17, 18, 21, 25, or 26. Except as required under subsection (B), the Board or its designee shall provide this information only if the requesting board states in writing that the information is necessary for an open investigation or complaint;
- A local, state, or federal law enforcement or criminal justice agency. Except as required under subsection (B), the Board or its designee shall provide this information only if the requesting agency states in writing that the information is necessary for an open investigation or complaint;
- The Arizona Health Care Cost Containment System [Medicaid] Administration regarding individuals who are receiving services under A.R.S. Title 36, Chapter 29. Except as required under subsection (B), the Board or its designee shall provide this information only if the Administration states in writing that the information is necessary for an open investigation or complaint;
- A person serving a lawful order of a court of competent jurisdiction; and
- The Board staff for purposes of administration and enforcement of A.R.S. § Title 36, Chapter 28 and this Article.
Am I the only one who thinks that's an awful lot of people to have poking through people's medication records? Note that access for law enforcement isn't conditional on a warrant, but only requires a written request stating that the information "is necessary for an open investigation or complaint." Uh huh. Don't tick off your neighbor, the state trooper.
And professional licensing boards have access to prescription information too. The specified professional boards with authority to leaf through your medication history include those regulating: podiatrists; dentists; traditional, osteopathic and naturopathic (but not homeopathic) physicians; nurses; optometrists; pharmacists; veterinarians; physician assistants; and security guards.
A "lawful order of a court of competent jurisdiction" could be just about anything -- including your ex-wife or husband taking a stab at revisiting your child custody rights. It could also be just about any fishing expedition related to a lawsuit.
And all of this is authorized access at the outset of the program. We can assume there will be pressure to expand access as the years go by -- the temptation to do so will be like ... well ... the bureaucratic equivalent of an addiction. And we can assume that some government employees will abuse access out of curiosity or for personal gain -- like the IRS agent who was sentenced to probation last year for snooping through the tax records of nearly 200 people, including celebrities. That was only the latest example of a problem (PDF) so pervasive at the IRS that it involved congressional hearings a decade ago -- which obviously didn't change anything.
Why would a centralized database of people's prescription history be any more immune to abuse than our frequently browsed tax records?
And make no mistake about it -- those records are sensitive. Schedule II drugs include drugs such as hydrocodone and oxycodone, schedule III includes testosterone and anabolic steroids, and schedule IV includes Librium, Valium and Ambien. There are perfectly good reasons for taking any or all of the affected drugs, but do you really want to have to explain those reasons to a licensing board, or a court -- or a journalist?
Oddly enough, for a program supposedly intended to combat "the inappropriate use" of controlled substances, the creation of the centralized medications database may be the best reason anybody could ever have for buying their drugs on the street.
Here's a thought: How about we take the government entirely out of the loop when it comes to acquiring and using the medications we want or need?