Pervasive Government Surveillance To Achieve Human Perfection: Prescription Drug Monitoring Programs

In the ongoing project to achieve human perfection through government action, pervasive surveillance of the population plays a growing role. After all, if the government can monitor everything you do all the time, then utopia will be just around the corner. The always-observing benevolent bureaucrats will be sure to make committing a crime completely unthinkable. The same goes for not paying your bills on time, or being mean to your wife — or criticizing those in power.

China, with its “social credit” system, is the leader in the movement toward pervasive government surveillance. This post of mine from September 2018 has a description of how the Chinese social credit system works; and the system has progressed substantially since then. A low score will restrict the schools you can attend, get you banned from high-paying jobs, and even deny you the ability to travel by train or plane.

Thankfully we don’t have anything like that — not! In fact we have multiple nascent and growing pieces of such a system. Mostly those pieces are being developed quietly and out of sight, without disclosure of what is occurring, so that it’s impossible for you to know exactly how much of your activities are being observed for later use against you. Big examples include government data collection on financial transactions (except those done with cash!) and the increasing data collection from automobiles.

There is one very big area of data collection on the population where quite a bit of information is available, both as to the data collected and the efficacy of the data collection effort in achieving the stated objective. That area is prescription drug monitoring programs (PDMPs).

Are you aware of PDMPs? These programs are initiatives of the states, rather than the feds (although I would have no doubt that the information collected is routinely shared with the feds). It is highly likely that you are subject to state monitoring of your use of prescription drugs, since 49 of the 50 states have such programs (the exception is Missouri). As with other government surveillance programs, the data collection proceeds in the background, without asking your permission or informing you that it is going on. However, by contrast with federal data monitoring of, for example, financial transactions, with prescription drugs you actually can find out the nature and extent of the monitoring program if you look into the matter. In most cases the answer is that your doctor and/or pharmacy transmits to a state bureaucracy information as to every prescription issued to you, and the state collects that information in a comprehensive prescription data base covering everybody.

The idea behind PDMPs is to prevent prescription drug abuse. Far and away the biggest area of alleged prescription drug abuse is the abuse of opioid pain killers, and indeed the supposed motive behind the prescription drug monitoring programs has been the effort to slow down or halt the scourge of opioid abuse and deaths from overdoses.

So how is it going? Of course, it’s an unmitigated disaster. Your privacy has been trampled, while drug overdoses and deaths have soared.

A good, short (6 page) history of these programs was issued in 2018 by the Heller School at Brandeis University, with the title “History of Prescription Drug Monitoring Programs.” The PDMP idea started slowly in 1918. By 1989, only 8 states had the programs, and they only applied to so-called “Schedule II” controlled substances — the hardest of hard drugs. But things accelerated in the 90s, and then took off after 2000. Not only did nearly every state ultimately adopt the programs, but they rapidly expanded them to apply to more and more drugs, and of course as the internet became more functional the programs moved online.

The Brandeis history, although indicating that the scope of drugs covered by the programs has greatly expanded over time, does not say whether every state program now applies to every drug, no matter how remote the chance of abuse or overdose. Here in New York, I can definitively say that our program for at least the last several years applies to every drug, including those for things like heartburn, blood pressure, and cholesterol. Because, why not? If a little surveillance is good, more must be better.

Here from the Brandeis history is a glowing summary of how great these PDMPs are:

PDMPs continue to evolve into one of the most efficient and effective tools in the battle to reduce prescription drug abuse and diversion. States are continuously improving their programs and being more responsive to stakeholders with more timely and accurate information. In contrast to early programs, today’s PDMPs are recognized as an important tool in addressing the drug abuse epidemic.

And the future is bright:

The effectiveness of PDMPs and the role they are playing in reducing drug abuse and diversion is very evident. . . . What started as embattled and fragile programs among a small number of states has grown into one of the most effective resource tools in the fight against prescription drug abuse and diversion. The future of PDMPs is on solid ground, and the full impact of these programs is just now beginning to be realized.

As you are reading this, you may be wondering: Is it actually right that these programs are “effective” in the “fight against prescription drug abuse”? Haven’t I read that opioid abuse and deaths from overdoses have in fact been soaring? You are not mistaken. Here from the CDC is a chart of what they call “drug-involved overdose deaths” from 1999 to 2021. Indeed, the numbers have been soaring:

And for the latest numbers I can find, here’s a White House press release from July 2023 giving a figure for “overdose deaths” of 109,940 in the 12-month period ending February 2023. The rate of increase may have slowed somewhat, but the increase continues.

So chalk these PDMPs up among the most disastrous of disastrous government programs intended to perfect the world. So is there any chance that these programs might get scaled back to give a little more government-free space back to the people? At least for now, I would say about zero chance. Very few people even know that these programs exist to complain about them.

And meanwhile, the big news from California is that it is going to integrate all its data about the population to create a new system called Cradle-to-Career (C2C) supposedly to improve career prospects for Californians. From The Spectator, November 10:

[Gavin Newsom] recently announced the creation of California’s new “Cradle-to-Career” (C2C) system. According to this official statement, the system will integrate “over 1 billion data points — providing unprecedented insight and transparency,” ostensibly “to improve career outcomes for millions of Californians.” C2C’s integration of data, notes the statement, “will provide the public, researchers and lawmakers unprecedented insight that could improve education and quality of life for millions of Californians.”

The Spectator thinks that California’s new program is highly analogous to the Chinese social credit system, and I think they are right about that.