The Use of Prescription Drug Monitoring Programs to Enroll Physicians into Policing Addiction

• In Event: The Interpretive, Affective, and Ethical Work of Big Data in Health Care and Medicine - I

Abstract

Data infrastructures have been used by US law enforcement since at least 1939 to surveil medically controlled substances—such as opioids—that patients receive. In light of the contemporary opioid crisis, lawmakers have provided physicians with access to the computerized forms of these infrastructures—prescription drug monitoring programs (PDMPs)—and required physicians to surveil patients as well. In prior research, we interviewed physicians, looking for usability issues in a physician-facing PDMP portal. It became clear that, in our search for “purely ergonomic” issues, we were missing an important pattern: Many features were usable for detecting and policing potentially “bad behavior,” but few were usable for understanding the arc of a patient’s “story.” This led us to the present work, in which we combine an analysis of the interview passages that did not fit a purely ergonomic narrative with a critical review of academic and gray literature, to investigate the political and social justice dimensions of PDMPs. We find that these circumstances have led to a dual view of addiction among physicians: that addiction is a disease and is also an “aberrancy;” an “abuse” of drugs or the system; a “suspicious” behavior. In this work, we examine how state governments use PDMPs to enroll physicians in the work of policing addiction. This enrollment is aided by informatics professionals and researchers, who have built these infrastructures, and are also continuing to build algorithms to quantify and predict the degree to which a physician will find a patient’s history to be suspicious.

Authors

• Mustafa Ibraheem Hussain, University of California Irvine

• Geoffrey C. Bowker, University of California, Irvine