The Prescribing Panopticon: A History of Prescription Drug Monitoring Programs

A Jay Holmgren

 

[This paper is currently in revisions for publication; please reach out if you would like more information.]
 
Prescription drug monitoring programs (PDMPs) have become a widely embraced policy solution to the 21st century opioid crisis in the United States. Despite mixed scientific evidence on their effectiveness at improving health and reducing overdose deaths, 49 states and Washington DC have adopted PDMPs, and they have received strong bi-partisan legislative support to strengthen incentives for their use. This paper explores the history of PDMPs, tracking their evolution from paper-based administrative databases to electronic tools that intervene at the point of care, to draw conclusions about what their popularity reflects about drug policy in America today. I argue that the ubiquity of prescription drug monitoring programs reflects a desire by policymakers to deliver solutions to the crisis without grappling with the difficult questions and political controversy surrounding alternative programs to treat substance use disorder such as naloxone distribution, safe injection sites, or medication-assisted treatment. Rather, PDMPs are a “safe” policy intervention that can be cast as a preventative effort to target bad actors such as “pill mill” prescribers. This characterization may have significant consequences for the patients and medical providers who are subject to government surveillance of their prescribing activity and ignores the continued usage of PDMPs by law enforcement in criminalizing substance use disorder. Myopic policy focus on supply-side restrictions may lead to worse outcomes for existing patients with substance use disorders.
 

Citing This Work

We are committed to sharing our work as widely and effectively as possible while protecting our students’ scholarship. Kindly contact course instructors Allan Brandt and Alyssa Botelho if you would like to cite or distribute this work in a professional venue (publication, presentation, etc.) so that we can be sure to provide you with the most up-to-date information about the student’s project.

brandt@fas.harvard.edu | alyssa_botelho@g.harvard.edu