Big Brother and Prescription Monitoring Programs

Though flawed, the Washington State Prescription Monitoring Program (PMP), which, like similar programs now in almost every state, allows me to access on the Web a database of controlled substances dispensed to a patient, has not only allowed me to learn more about current patients but has also allowed me to screen prospective patients to identify those whom I might not want to treat. I now routinely check the database before a scheduled first appointment and have cancelled several based on what I read.

It occurred to me that the prescribers whose names appear on the reports might like to see the reports themselves, which raises confidentiality questions, but puts them on notice that the patient may have sought drugs from prescribers of whom they were unaware. Although I now possess a report, no patient physician relationship has been established, and the other prescribers can access the records anyway, so I am not really divulging anything.

Suppose the patient herself holds a professional license. Perhaps I have a duty to report to the licensing board because of possible impairment. Perhaps the record reveals a prescriber with a pattern of overprescribing. Perhaps the record reveals a patient who doctor shops for drugs. Can I share this information with the Deparment of Health or other regulatory agency?

According to this statute such agencies already have legitimate access to the database:

"The department may provide data in the prescription monitoring program to the following persons,...

"(c) Health professional licensing, certification, or regulatory agency or entity;"

Then it occurred to me that if these agencies can legitimately access the data, they can also mine the database. The Medical Quality Assurance Commission could, for example, match physician names and birthdates from the licensee database to patients' names in the prescription database in order to identify patterns of physician use of controlled substances as patients that suggest likely impairment. MQAC could also look for patterns of overprescribing by matching prescriber names. The same holds true for other professionals as patients and for other professionals as prescribers.

How do we balance privacy against other interests, especially when early identification of substance abuse by licensed prescribers might lead to interventions that could save their own lives? Why should the state hold professionals responsible for reporting when licensing agencies already have legitimate access to the information? If the state has access to this information it is disingenuous to assign treatment providers the job of reporting. 

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