[CodeAndCuffs]

I used to work in Drug Diversion investigations, which is basically any time a prescription medication gets used from something other than intended bona fide medical use. Sometimes its doctors selling prescription drugs for non-medical use, sometimes its medical staff stealing.

The biggest thing we covered was prescription fraud. People stealing or forging doctor's prescriptions. Some were more subtle about it. Sometimes you'd see a patient filling a 30mg Oxycodone, 90 count.

Leads would come from either the Doctor, or the pharmacy. 30mg Oxycodone/90 is generally a "You are in massive pain and probably dying" prescription. So when a health 20 something year old walks in and has it filled for themself, it raises some eyebrows. They'd either call the Doctor to verify, who'd call us to investigate, or theyd call us and then we'd call the doctor.

But the state already has access to this information. All prescriptions are logged in the Prescription Monitoring Program, which I believe all states how now. Any Doctor can get a spreadsheet of all prescriptions filled in their name over the last N days, who it was prescribed to, what for, and when. It was an invaluable tool. Doctor Adams tells us he never wrote this prescription for Bill. We lookup Bill and see he has filled similar suspicious prescriptions from Doctor Charles and Doctor Daniels. We talk to Charles and Daniels and they tell us that Bill isnt their patient either. We encourage Charles and Daniels to check their PMP report, and they uncover 4 or 5 more suspicious prescriptions, and we just keep pulling at this thread uncovering more and more.

Of course there is potential for abuse and neglect, but we werent (and couldnt, legally) just go into a pharmacy and ask for random documents, or lookup random names on the PMP. We had to have an initial lead, usually a doctor, or a pharmacist, who saw something suspicious. From there, its just checking state records, verifying what we saw with doctors, and getting paper evidence of the stuff we already knew was false. I had maybe 3 cases where we had a red flag, called the doc, and they doc said "Yeah thats legit" and that was the end of the conversation. I don't need to know why this patient is on this narcotic, I just needed to know if it was a fraudulent. If its not, then thats between the doc and the patient.

State law gave us authority to request pharmacy records, i.e. prescriptions and pickup logs, without a warrant. Most pharmacists did it with no hesitation. A few would want to make sure it wasn't a HIPPA violation (it wasnt) and that it was legal (it was).

Concerningly, I did have a_couple instances where I asked for documents and the employee started to provide them before I had a chance to identify myself.

In summary, if we were to blindly look at someones medical history or records without a bona fide articulable suspicion of a crime, it'd be massively illegal. If we did have a reason to look at the records, its because someone in the medical field saw something suspicious and reported it. From there we were mainly looking at records the government already had, and then finally getting medical records from the pharmacy that was just paper evidence of records we already had.

[chimeracoder]

> In summary, if we were to blindly look at someones medical history or records without a bona fide articulable suspicion of a crime, it'd be massively illegal.

It's extensively documented that law enforcement breaks laws all the time. Your comment isn't reassuring at all - in fact, you're just describing how normalized the process for violating the 4th Amendment and patients' privacy is.

[CodeAndCuffs]

> how normalized the process for violating the 4th Amendment and patients' privacy is.

Well thats the rub, isn't it? Right now the courts don't see this as a violating of the 4th amendment. I can see the argument for requiring a warrant. Im not necessarily against the requirement, but this isn't normalizing a 4th amendment violation any more than license checkpoint (which the courts have also ruled isn't a violation)

[Edited to add the rest of the quote]

[WarOnPrivacy]

> State law gave us authority to request pharmacy records, i.e. prescriptions and pickup logs, without a warrant.

This is good to know.

It is proposed that this arrangement be modified to require a warrant.

Although I am comfortable accepting that your agency demonstrates the integrity you indicate, there are ~18k other law enforcement agencies in the US. A not insignificant number have long and well-documented histories of excessive and inappropriate record access. (And many, many other LEA have similar histories, even if they don't overreach as often.)

A warrant provides some judicial oversight. When accessing our private and confidential information, this is the reasonable default.

[chimeracoder]

> It is proposed that this arrangement be modified to include a warrant requirement.

That defeats the entire point of this arrangement, which allows them to investigate in situations where the legal requirements for obtaining a warrant are not met. (Which is the elephant in the room: the entire premise of this system is to bypass established legal thresholds).

> Although I am comfortable accepting that your agency demonstrates the integrity you indicate

I'm not sure that's a safe assumption. As you mention, system abuse by law enforcement is incredibly common at agencies across the country. If you talk to any person at one of those agencies, they will almost invariably tell you that their coworkers take their job seriously, that they never abuse their own power, and that they can't imagine their coworkers doing the same.

[1920musicman]

To play devil's advocate: sounds like a "bona fide articulable suspicion of a crime" doesn't necessarily mean there is a documented reason for the release of records that has been authorized by a judge. Wouldn't that leave too much space for abuse?

[CodeAndCuffs]

Yeah, it could. People can also lie on affidavits for warrants, but it does leave more of a paper trail to catch the guy. Honestly I don't think I'd be against a warrant requirement, but I also think we need a way to speed up the warrant process a _lot_. Right now it often involves a 1 hour + drive to a magistrates office, 30-45 minutes of filling out paperwork by hand, plus the hearing, getting the actual warrant printed+signed+logged, then 1 hour + drive back to where you need to be. I think you'd see less pushback of warrants in general if it leveraged the technology we have. We should absolutely be able to file an affidavit electronically, facetime a magistrate, and get a warrant approved/denied that way.

But again, getting records from the pharmacy isn't really the issue. The government already has the records of the doctor that "wrote" the prescription. All the pharmacy is giving you is the physical copy of the record + data of who picked it up.

[transfer92]

I used to be analyst in a related area. I was impressed by the difference in the treatment of commercial databases (e.g. LexisNexis) and government databases that had data that was controlled under laws.

As far as the commercial databases were concerned, I don't think we were told much more than this costs money, so don't waste searches.

But as for things like criminal history searches ("RAP sheets") we had training that stressed the illegality of looking up anyone without a justifiable legal reason. We were told to log the reason for doing every search. The training materials included news clippings about former police officers who were in prison for invalid use of the criminal history database. Once a year we were audited and asked to justify a selection of lookups we had done.

All systems are faillible and can be misused by bad actors. All systems are subject to cost-benefit analysis.

But I think it's valid that we have a system of law enforcement, that it be able, under appropriate circumstances and laws and checks and balances, to gain information that is sensitive and not publicly available.

[SheinhardtWigCo]

Surely this all becomes unnecessary with mandatory e-prescribing for controlled substances?

[zoklet-enjoyer]

You should mind your own business and let people put whatever they want into their bodies

[caskstrength]

Yeah, don't know why are you being downvoted. According to OP's description it is just big waste of money and erosion of privacy to catch some people who don't really hurt anyone.

[dkn775]

If one is to fill a rx meant for someone else (c2), ie someone diverts their legit RX to an addict who pays them and fills it

Does this data get linked with the addicts other rxs in their name

[everforward]

Some meds require the person picking up to show ID, and they record the ID, so maybe?

[jvanderbot]

I definitely appreciate the context here. It adds some color to breathless headlines.

I'm curious what other precedents there are for this. Can a state policing agency of some kind go and pull purchase records for a credit card by name? Could they extract search history, drive destinations, music lists, or something else without warrant? It's not clear to me where the distinction between "warrant-less search/seizure/wiretap" crosses into "Get all data about a person who is outside their home for free".

[chimeracoder]

> Can a state policing agency of some kind go and pull purchase records for a credit card by name? Could they extract search history, drive destinations, music lists, or something else without warrant? It's not clear to me where the distinction between "warrant-less search/seizure/wiretap" crosses into "Get all data about a person who is outside their home for free".

Yes, law enforcement routinely goes to private companies to get data without a warrant, oftentimes in cases where a warrant would otherwise be required.

For example, Google only _just_ changed their internal policy of handing location data to LEO without a warrant - and while this sounds like great news, it's not as big as it seems, because other players (e.g. cell carriers) also have that data and are much more likely to hand it over than Google is. https://time.com/6539416/google-location-history-data-police...

[voldacar]

This seems deeply antithetical to a free society

[buryat]

all of this for 90/180/270 pills?