A pharmacist wearing a white coat working at their lab station. Image by Polina Tankilevitch under Pexels license.

Over 500,000 Americans have died as a result of opioid overdose since 1999. Policymakers, police, and medical professionals are all trying to understand and prevent overdose. For example, pharmacists now use computer programs that track how often patients refill their prescriptions called ‘Prescription Drug Monitoring Programs’ (PDMPs). 

Because these prescription tracking programs were designed for law enforcement, some worry they might be subtly pressuring pharmacists to be more focused on policing than providing patients with care. Supporters of these PDMPs say they can eliminate biases by automating decisions about prescription eligibility and giving pharmacists a formal justification to turn patients away.

Elizabeth Chiarello interviewed 118 community-placed pharmacists to learn how the new PDMP databases affected their work routines and relationships with other professionals.  

Chiarello found that as pharmacists used the PDMPs, they reoriented their work around crime and the legal system, rather than health care logics. This shifted their treatment of prescription misuse from a rehabilitative one to a more punitive one. She therefore describes PDMPs as ‘Trojan Horse Technologies,’ based on the classic story of the soldiers hidden inside the giant horse that the Greeks gifted to the Trojans; 

“Whereas the Greeks leapt out of the horse to massacre their enemies,” Chiarello writes, “the criminal-legal logics embedded in the PDMP emerge slowly as pharmacists use PDMPs in daily practice,” which gradually transforms the pharmacy field.  

Pharmacists are now expected to act as an extension of law enforcement, reporting patients and restricting their ability to access medicine rather than helping them get the treatment they need. 

Through the adoption of PDMPs, law enforcement may have subtly deputized pharmacists to criminalize prescription misuse. Although pharmacists have historically resisted this role, PDMPs have become systematized and made pharmacists more comfortable policing their patients. Chiarello concludes that pharmacists would be less inclined to police patients, and more inclined to care for them, if they had access to different treatment tools, such as the ability to provide medications for substance use treatment under a physician’s supervision.