North Carolina Sheriffs Want To Know Who Is Taking Painkillers

Thursday, September 9th, 2010

Wow, is this ever a terrible idea.

Sheriffs in North Carolina want access to state computer records identifying anyone with prescriptions for powerful painkillers and other controlled substances.

The state sheriff’s association pushed the idea Tuesday, saying the move would help them make drug arrests and curb a growing problem of prescription drug abuse…

Sheriffs made their pitch Tuesday to a legislative health care committee looking for ways to confront prescription drug abuse. Local sheriffs said that more people in their counties die of accidental overdoses than from homicides.

For years, sheriffs have been trying to convince legislators that the state’s prescription records should be open to them.

“We can better go after those who are abusing the system,” said Lee County Sheriff Tracy L. Carter.

In addition to the obvious privacy, doctor-patient privilege, and Fourth Amendment concerns, a policy like this is likely to exacerbate the undertreatment of pain. The sheriffs argue that giving them access to the database will help them catch doctors who over-prescribe and patients who shop from doctor to doctor when they’re denied access to painkillers. I’m sure there are examples of both misbehaving doctors and patients. But in the past, law enforcement officials’ definition of over-prescribing has sharply diverged from that of pain professionals. High-dose opiate therapy, a promising new treatment for chronic pain, has basically been cut off at the knees because of high-profile cases in which DEA officials, U.S. attorneys, and state and local law enforcement with no medical training have taken it upon themselves to decide what is and isn’t appropriate treatment.

And the problem is self-perpetuating. As more doctors leave pain management out of fear, those left feel pressure to take on more patients. And the fewer doctors willing to prescribe pain patients the meds they need, the more doctors legitimate patients need to see to find one who will give them proper treatment. Both are consequences of bad policy. And both are then considered by law enforcement to be signs of abuse.

Letting cops go fishing in patient databases for these “red flags” is only going to make it all worse. Sure, they may well find a few unscrupulous doctors, and perhaps some people who are using doctors to feed an addiction. But one thing that’s almost certain to happen is that doctors are going to become even more fearful that every script is going to be scrutinized. Which means fewer of them will be willing to write them. Which means more pain patients are going to suffer, despite the fact that there are drugs available to help them.

My archive of pain treatment posts here.

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53 Responses to “North Carolina Sheriffs Want To Know Who Is Taking Painkillers”

  1. #1 |  Joe | 

    What could go wrong?

    [hint: a lot]

  2. #2 |  Dave Krueger | 

    I remember one of the complaints about government health care was the fear that “the government would come between you and your doctor”.

    What a friggin’ joke. The government is already coming between you and your health care by requiring prescriptions for almost all new medications.

    That people actually even entertain an idea like police agencies having access to medical records is scary. And this at a time when its becoming less radical to suggest dismantling the drug war (at least by us radical libertarians). Hell, I could actually envision some recreational drug laws being relaxed even as government intrusiveness is increased. After all, if recreational drugs were made legal, the need for government oversight of drug use would actually increase, wouldn’t it?

  3. #3 |  PeeDub | 

    Depressed at the recent volume of NC-related despair …

  4. #4 |  Dante | 

    Deputies get to decide your medication levels?

    Who in the world would think that was a good idea?

    Oh. Law Enforcement. I guess they need a new cash cow.

    They’re the same folks who believe that in order to “save the children” they need to bust down the wrong door and shoot the children.

    I can’t wait until the rest of the country realizes, as most here do, that the greatest threat to the average American’s life, liberty and pursuit of happiness is an encounter with Law Enforcement.

    Protect & Serve (Themselves !)

  5. #5 |  Upgrayyed | 

    You forgot settling personal vendettas as well.

  6. #6 |  Aresen | 

    …and perhaps some people who are using doctors to feed an addiction.

    Which is still an issue for the doctor and the patient. It is none of the government’s business.

  7. #7 |  Waste93 | 

    I would think HIPPA would prevent this disclosure without a court order. HIPPA prevents giving out personal medical information, which should include ones prescriptions, to third parties. This includes law enforcement without a court order.

  8. #8 |  Clark | 

    While unrelated, this makes me glad that I recently recommended to a relative here in NC that instead of prescribed painkillers for arthritis of the spine, they try marijuana. I don’t think that they will be keeping a record of every pot purchase in the state.

  9. #9 |  qwints | 

    Radley, you’re obviously only bothered by this because you have the wrong priorities. Alleviatign suffering is less important than preventing people from getting high.

  10. #10 |  alkali | 

    There was recently a good decision from the high court in Massachusetts upholding patient-doctor privilege against a similar law enforcement request.

  11. #11 |  A McGillican | 

    Here’s an idea. If the police want to find people abusing the system, they could do an investigation and get a warrant from a judge. Oh wait, that means they will have to do some real police work instead of throw any person in jail to meet their quota.

  12. #12 |  Old Fart | 

    HIPAA expressly provides that its provisions preempt any contrary provisions of state law, unless one or more listed conditions are met. So, if a state PMP (prescription monitorning program) law requires disclosure that is not permitted under HIPAA, HIPAA will preclude providers and dispensers from complying with such state PMP requirements.

    Of course one of the “conditions” listed to allow states to exempt themselves, and what the cops will likely use as justification is…

    Provision of State law provides for reporting of disease or injury . . . or for
    the conduct of public health surveillance, investigation or intervention.

    A loophole in HIPAA enforcement big enough to drive a heavily armored assault vehicle through.

  13. #13 |  Waste93 | 

    Old Fart,

    It would be up to a court to decide if those exemption applied. I don’t think they would. They are not asking for a reporting of disease or injury. They are asking for information on the treatment. Also I think most courts (maybe) would state the public health surveillance, etc is in regards to communicable diseases.

    So I still think there is a fair chance HIPPA would shoot this down. Also once the state figures out the liability issue any time this information gets released to the public they may back off. At least we can hope so.

  14. #14 |  Mattocracy | 

    So medical patients are criminals now. Awesome. Cause having pain must mean you’re guilty of something.

  15. #15 |  Dave Krueger | 

    By the way, what are unscrupulous doctors? Are those the ones that cave in to the wishes of patients who have the unmitigated gall to think they can decide for themselves what to put in their own bodies? I mean, who the fuck do they they think they are, anyway?

  16. #16 |  Boyd Durkin | 

    Cop Union right now is struggling with the advantages of being able to use this info to settle personal vendettas and find out what Lady GaGa is on…and the disadvantages of allowing the government to see what and how many drugs cops use.

    Solution: carve out cops as “protected” and not have their info available for review.

    Really a win/win.

  17. #17 |  Jerri Lynn Ward | 

    I think that Old Fart has a good point. There is a law enforcement exemption in HIPAA. Here is a powerpoint in HTML form regarding it. It’s a pretty broad exemption.
    http://webcache.googleusercontent.com/search?q=cache:_sRlK3yOOkwJ:www.hipaacow.org/Events/Fall%25202005/WHIMALawEnforcement.ppt+law+enforcement+exemption+Hipaa&cd=1&hl=en&ct=clnk&gl=us&client=firefox-a

    I represent health providers and from day one, I felt that HIPAA was a big scam to permit more government access to phi, not less.

  18. #18 |  Boyd Durkin | 

    So I still think there is a fair chance HIPPA would shoot this down. Also once the state figures out the liability issue any time this information gets released to the public they may back off.

    Yes, but I thought many cases of eminent domain abuse would be decided by the courts in favor of the property owner. As for liability issues, the skeptic in me sees no motivation for states to hide from lawsuits although I heard this was once the case a long, long time ago. Today, the public foots the bill and the state agent has no personal liability.

    HIPAA was made by government and can be changed by government. It will bend to serve the purpose of the state.

  19. #19 |  Robert | 

    I live in NC. Recently changed doctors because mine moved out of state. When contacting the new doctor, the first question they asked was “Is this for pain medication?”.

  20. #20 |  Rhayader | 

    Goddamn fucktards. Let’s squeeze the balloon here now.

    I’m a reluctant North Carolinian, to whom should I bitch?

    I don’t think that they will be keeping a record of every pot purchase in the state.

    Does he have a good hookup? Been here for two years and I’m still
    strruggulling.

    (I wanna kiss you.)

  21. #21 |  Matt | 

    “Sheriffs in North Carolina want access to state computer records identifying anyone with prescriptions for powerful painkillers and other controlled substances.”

    Uh huh. And *I* want access to every cop’s home address and work schedule. I think that’d be a fair trade.

  22. #22 |  EH | 

    Uh huh. And *I* want access to every cop’s home address and work schedule. I think that’d be a fair trade.

    I think access to their prescription records would be plenty to figure out how many are on anti-rage drugs and/or steroids.

  23. #23 |  Salt | 

    Such a measure would provide additional avenues for residential invasions by “Prescription Enforcement Task Forces,” dead citizens, murdered puppies, property damage, and a host of abuses under the color of law.

    Top it off with a dab of database abuse, mix in some privacy invasion, and voila, a nice pot of totalitarian stew.

    Does any rational mind think there would not be knocks on doors (or doors kicked in) to inspect medicine cabinets as a result of this?

  24. #24 |  Brandon | 

    Why can’t any adult who so chooses just buy opiates, whether they’re in pain or just want to have a good time?

  25. #25 |  Waste93 | 

    Jerri,

    The law enforcement exception only allows the HIPPA provider to provide identification information to law enforcement. What this means is that if the police are looking for someone they can call the service provider and ask if they are there. They can also get personal identifiers (height, weight, clothing, ethnicity). They are specifically not allowed to get medical information without a court order. The one exception is if the service provider is calling in a crime such as an assault or rape, they can give some basic medical information (extend of injuries) to the police. Which is why hospitals can be required to report gun shot wounds and the like in most states. But the LE exception is not nearly as expansive as you fear.

    The reason that is in there is that police would be looking for a criminal and providers were declining to even tell the police if that subject was at the location. Even when the police already had the name and date of birth of the person they were looking for. But giving identification information is a far cry from giving medical information.

  26. #26 |  sean sorrentino | 

    In NC in order to buy a pistol you have to get a purchase permit from the sheriff. Will he be pulling a New York State and looking up my perscription history while he decides? How about my concealed license?

  27. #27 |  Marty | 

    #7 | Waste93

    ‘I would think HIPPA would prevent this disclosure without a court order…’

    cops already enjoy special privileges with regards to prescription medicines. it’s difficult for most people to legally dispose of outdated drugs or narcotics (usually they flush them or toss them out, but there are environmental concerns), but they can turn them into any police station. they aren’t burdened with the paperwork and bureaucracy everyone else has to work through…

  28. #28 |  SJE | 

    So cops want access to our private medical records but we cannot even videotape them?

  29. #29 |  StrongStyle81 | 

    If they get this power the consequences of it are fairly plain. No longer will law enforcement will use just marijuana or other illegal drugs as an excuse to use SWAT teams to raid family’s homes. Anyone with a legal prescription from a doctor is a target. No doubt, they’ll confiscate homes and property as this will no doubt fall under the War on Drugs banner. This has to be stopped at any cost. Law enforcement is declaring war on American citizens.

  30. #30 |  Waste93 | 

    #26 Marty,

    Voluntary giving up narcotics to a PD for destruction, something they do with seized narcotics also, is not the same thing as being able to pull up someones prescription history. To two are not comparable.

    And there is some paperwork involved. They have to go into evidence and there is a paper trail to their destruction.

  31. #31 |  JS | 

    StrongStyle81 ” Law enforcement is declaring war on American citizens.”

    pretty much sums up life in America today.

  32. #32 |  random guy | 

    Seriously what the hell is happening in NC? I’ve lived here my whole life thinking this was a pretty laid back state and this stuff is starting to piss me off. Openly corrupt SBI? Check. Random police slayings (by not of)? Check. Cops digging through medical records to create some imaginary crime of painkiller abuse? Check. Just last month the sheriffs had both ways blocked off on a road near my house to do a “license check” on every motorist going through, which I’m pretty sure was ruled unconstitutional in the 80’s.

    What are good states for libertarians to live in? I’ve heard Alaska, Nevada, and New Hampshire were decent. Not to keen on the first two but i could handle living in new england.

  33. #33 |  J.S. | 

    “Local sheriffs said that more people in their counties die of accidental overdoses than from homicides.”

    So how exactly will the cops knowing who’s on what painkillers prevent accidental overdoses? Random house calls on the “junkie scum” to make sure they’re alive, well and hopped up on goofballs? Arrest them if they step outside for public drunkeness?

    When did it fall to the purvue of the police to deal with accidental overdoses? I guess they feel its the next step since they succeeded so well with making sudafed prescription only in some states.

  34. #34 |  Sky | 

    Not that I needed a good reason but this is a good one for not living in NC.

  35. #35 |  Michael | 

    Really, bottom line is that the LE think it, somehow, makes them more important if the “take down a (rich) doctor”. They act like scum!

    What makes me mad is that the LE in LA county appeared to be making as much money as doctors. They did that without the decade training we take! They have been trying to play doctor for years. With the DEA in tow, they have ruined many doctors’ lives. Sad thing was, when I contacted prosecutors about patients, that had been found to be doctor shopping, they did not do a damn thing! They wanted me!

    I read the Times article, yesterday when it came to the house, about the “pain medicine scourge” (the latest). It was so poorly written and had so much misinformation in it, I would not doubt that it was one of these sheriffs that wrote it! (just kidding). I just love how it seems that everyone and his brother is smarter than the doctor, nowadays! Glad I don’t have to deal with them anymore! Other than wasting my entire life for my, useless, education, I have few regrets!

  36. #36 |  KristenS | 

    @random guy – New Hampshire is good – no state income state or sales tax. I’m a Vermonter, so I have a soft spot for that state. Almost no gun laws in VT. THe politics of the state is a weird mix of libertarian and socialist. I think VT is fairly business-friendly, but don’t quote me. All I know is there always seems to be lots of new business popping up in VT, and many are hugely successful (Ben & Jerry’s and Vermont Teddy Bear to name two)

  37. #37 |  Jerri Lynn Ward | 

    Wasted, I’m not sure that disclosures to law enforcement are limited to that. C below is the section I would worry about in the context of what the Sheriff is asking:

    (1) Permitted disclosures: Pursuant to process and as otherwise
    required by law. A covered entity may disclose protected health
    information:
    (i) As required by law including laws that require the reporting of
    certain types of wounds or other physical injuries, except for laws
    subject to paragraph (b)(1)(ii) or (c)(1)(i) of this section; or
    (ii) In compliance with and as limited by the relevant requirements
    of:
    (A) A court order or court-ordered warrant, or a subpoena or summons
    issued by a judicial officer;
    (B) A grand jury subpoena; or
    (C) An administrative request, including an administrative subpoena
    or summons, a civil or an authorized investigative demand, or similar
    process authorized under law, provided that:
    (1) The information sought is relevant and material to a legitimate
    law enforcement inquiry;
    (2) The request is specific and limited in scope to the extent
    reasonably practicable in light of the purpose for which the information
    is sought; and
    (3) De-identified information could not reasonably be used.

    http://edocket.access.gpo.gov/cfr_2007/octqtr/45cfr164.512.htm

  38. #38 |  TDR | 

    At this point, I don’t even think it would matter if we legalized marijuana or ended the WOD. They have control of every aspect of our lives. To be regulated is almost worse than to be outlawed.

  39. #39 |  Marty | 

    #29 | Waste93

    I agree that they’re not the same- I was pointing out that I know they already have special privileges not granted to others with regards to prescription medications. this is especially true regarding narcotics.

    this leads me to suspect that they could end up with access to narcotics records…

  40. #40 |  damaged justice | 

    “Why can’t any adult who so chooses just buy opiates, whether they’re in pain or just want to have a good time?”

    Because if they do, thugs with guns will shoot them. And their dog.

  41. #41 |  jppatter | 

    Local sheriffs said that more people in their counties die of accidental overdoses than from homicides.

    Not sure how to say this without sounding like a cold, heartless jerk, but … so what? Why does the state care if someone dies of an accidental (or even intentional) overdose. Homicide? Yes, that is the state’s business. But if I accidentally take too many pills, that is a matter between me, my family and my friends. Perhaps SOCIETY would be harmed by my accidental death, but the STATE would not. And even though I cannot imagine a scenario where I would intentionally take too many pills, again, how is that any of the state’s business. Hopefully my family and friends would care but Big Brother/Big Mother can just butt out.

  42. #42 |  ktc2 | 

    The only person / agency that HIPPA protects your medical records from is YOU. It was yet another program that does the opposite of it’s claims and name. It allowed many, many organizations access to your records law enforcement, pharmaceutical companies, etc.

  43. #43 |  perlhaqr | 

    As an EMT, my answer to the problem of accidental overdoses and whatnot is: The FDA should mandate that every package of heroin sold off the shelf at CVS or Walgreens meet purity standards and include a multidose Narcan autoinjector.

    And other than that, stop fucking with cancer patients or people with back pain from car accidents, or really, even just people who want to get high for fun.

    —-

    @random guy, #32: New Mexico isn’t bad, really. There’s a pretty big undercurrent of “leave other people alone” here, on a cultural level. I found Las Vegas, NV, to be far more stifling of individual freedom than Albuquerque. (Las Vegas has a very surface, “cake and circuses” hedonism and liberty going for it. But you have to register your handguns with the police. I was always catching a very heavy “that which is not forbidden is mandatory” vibe out of the place.)

    But we also have a pretty chronic nepotism problem in our government. And we’re pretty much literally dirt poor. So the local university is well staffed with highly paid Officer level positions filled by cousins and friends of the Governor, but can’t actually afford to run the departments those people head, for example.

  44. #44 |  Grenadier1 | 

    Sorry but Doctors brought all of the heat on themselves when they used the government to mandate the need for medical licenses. They could not be content with a simple board of their peers issuing a certification. If I want Granny Grunt down the street to treat me with ancent herbal remidies then its no business of anyone elses. No storm troopers should have the power to bust down her door and shoot her for practicing medicine without a state issued peice of paper. Now that rant aside this is an extreamly bad idea and many have already said why.
    I think at least if they are going to do this that the medical records of all police and politicians be a matter of public record.

  45. #45 |  paranoiastrksdp | 

    jppatter, it’s because no one wants to take responsibility for the stupid shit they pull. A family doesn’t want to blame the family member for ODing on the drug. They want to blame the drug dealer (doctor?). They want to blame the drug itself. They never want to concede that maybe, maybe said family member was responsible for their own demise. Then they scream at legislators to do something, which usually involves less freedom and privacy for everyone else.

    Here in rural Appalachia it’s very common to hear people blaming Oxycontin for all of their woes – as if the magic little pills just leaped into their mouths!

  46. #46 |  Old Fart | 

    I should have come back here yesterday for more of this, but I got busy.

    @Waste93 : this isn’t about them getting the information from service providers, you are correct that they’d need a court order for that. The state already gets the information from service providers by using a PMP law… the popo want the info from the state. If the state PMP law is lax enough, no judicial review is needed… per HIPAA exemptions.

    I currently work for a large fortune 100 insurance company, and used to work for a health insurance company… I have to take yearly HIPAA quizs to make sure I understand the law (as best as a non-politician can anyway).

  47. #47 |  Carol M. | 

    I can imagine many forcible entries by police, tazerings and shooting galore. Not to mention many jailings for all sorts of reasons limited only by the arresting officers’ imaginations.

    Pain control, already difficult enough for patients and doctors, will become even more of an impossible. awful situation to deal with. Just a few of the benefits to be had by handing more control of your medical care over to your local criminal justice graduate (I guess) who got to be a deputy. Who needs to molly coddle patients anyway!

    Seriously, how do we make sure this does NOT happen?

  48. #48 |  Voltear | 

    “More power! More power! More power! More power! ad nauseam infinitum…”

    Either the Sheaple start reclaiming their rights or we will have to endure a Soviet-style meltdown and subsequent blatant fascist takeover. It’s time to man the barricades and storm the Bastille.

  49. #49 |  tjbbpgobIII | 

    Well G_ _d dammit, what are they gonna do with all the soldiers and Marines who will have to look for a LE position (why is that called a position and everyone else just has a job) when obummer ends the war on terror. You should also believe that when we “give them this inch_ _ “

  50. #50 |  T'Mershi Duween | 

    I think this story kinda dovetails with something I noticed while doing a lap of the Republic. When we were in Cali, we saw marijuana everywhere. People were smoking it with relative impunity. We even saw a bus parked at a rest-area on US 1 with a banner on the side, reading something to the effect of “broke down, out of money, out of weed, help appreciated.” Just in passing, we saw him getting smoked up by three people. That’s Cali.

    Then there’s Tennessee. We stayed in Lynchberg for a few days. There, I saw several “pain management” clinics. These “clinics” looked and were situated like fast food joints. I talked to a local ne’er do well and he gave me the rundown on the pain management gig: go in, complain about back pain, get a scrip for oxys, but you have to take a piss test. If the piss test comes up positive for marijuana, you’re off the pain management ready roster for access to the opiates that they distribute (for a healthy profit).

    I imagine this is the cops trying to get a handle on the “pain management” profit scheme.

  51. #51 |  Caliguy58 | 

    This is by far the most ignorant idea I ever heard. Who do these Sheriff’s think they are to be making medical judgments about the prescription of pain medications. It’s sheer stupidity and should be nipped in the bud.

  52. #52 |  “North Carolina Sheriffs Want To Know Who Is Taking Painkillers” | 

    […] For your own good, of course — and so that they can make more arrests. [Radley Balko] […]

  53. #53 |  Justice | 

    I cant believe how much this starting to effect everything, patients in hospitals, dentist offices etc.
    I was in the Er on news year 2011, and while there I was giving morphine because I was in tremodous pain. The morphine made me sick but it helped, and then after the hospital had no answers for why I was in pain, they sent me home in pain with 5mg loratabs. Now that is not right.
    Today I had two filling, a root canal and all my teeth buffered to removes stains, and I was sent home with Motrin, my mouth hurts so bad right now and all the dentist is offering is tylenol 3..
    This is effecting everyone I know! Some people really need pain medication and they need it “for there pain, and not to sell”. Maybe the sherrifs need to look into that, because this is the reason why people are seeking to buy them off the streets. Yes N.C. cut everyone off of narcotic’s and then see what kindof problem you will have then!
    I agree yes people abuse them, and they overdose on them, but some of us like me do need these meds for pain!

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