Prescription drug monitoring programs trace back to the 1940s as a technology designed for law enforcement to track illicit drugs. Since the early 2000s, health care systems have used such programs to combat opioid misuse. That has affected what’s expected of medical professionals and changed their relationships with patients in ways that have contributed to patient criminalization and increased rates of overdose.
St. Louis University associate professor Elizabeth Chiarello joined St. Louis on the Air to discuss her new book, “Policing Patients: Treatment and Surveillance on the Frontlines of the Opioid Crisis.” In addition to describing how prescription drug monitoring programs have “blurred boundaries between health care and law enforcement,” Chiarello shared the real-life situations that patients face when medical care is governed by strict adherence to federal opioid dosage guidelines rather than individual patient needs.
“The prescription drug monitoring program is part of the set of tools that doctors use to police patients, and it is part of a process of criminalizing care. But we also, as a culture, treat people who have substance use disorders and people in pain quite terribly,” Chiarello said.
As to increases in overdose, Chiarello referred to a phenomenon drug policy researchers call “the iron law of prohibition” — which is, essentially, replacement of one hazardous substance with another.
“We went from prescription opioids contributing to a lot of deaths to heroin contributing to a lot of deaths. Now it's almost exclusively illegal fentanyl. You crack down on a safer drug and a less safe drug takes its place. So that's why we're in a moment now where we're seeing a lot of fentanyl and a lot of xylazine, which is an even more problematic drug,” Chiarello said.
She also put a recent NPR exclusive about a sudden, unprecedented nationwide drop in drug overdose deaths into larger context. While acknowledging the roles that wider availability of overdose medications like naloxone, growing access to opioid misuse treatments and emergence from the COVID pandemic may have played, Chiarello also pointed to the reality that the opioid epidemic is still a public health emergency.
“We haven't seen that big of a drop the entire time we've been stuck in this [opioid] crisis, so it's very exciting. But we have to get the story right. … We as researchers have an obligation to find out exactly what factors led to those declines, and then our political leaders need to go all in on what works,” Chiarello said.
“Imagine for a minute that you were losing $10,000 a month, and then things changed, and you were losing $8,000 a month. You would be relieved, but I don't know that you would be entirely celebratory. And these are not dollars, these are lives,” she said. “When you keep in mind that every single one of these deaths is a preventable death, we still haven't gone far enough to save the lives that we can save.”
To hear what “pain contracts” between physicians and patients do, how law enforcement uses PDMPs to track doctor prescription practices and about a new program to train pharmacy workers to provide community health resources, listen to St. Louis on the Air on Apple Podcasts, Spotify, or YouTube; or click 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. Jada Jones is our production assistant. The audio engineer is Aaron Doerr.
