The opioid crisis is one of the largest public health problems in the history of the United States. Prescription drug monitoring programs (“PDMPs”)—state databases containing the records of all prescriptions for controlled substances written in the state—have emerged as a means to track opioid prescribing and use. While PDMPs are typically used as a tool for physicians to inform their prescribing practices, many states also permit law enforcement to access PDMPs when investigating controlled substance distribution, often without prior judicial approval. Such law enforcement use of PDMPs raises serious questions of patient privacy. The Fourth Amendment protects individuals from unreasonable searches and seizures where they have a reasonable expectation of privacy and has been interpreted to require law enforcement have probable cause and a search warrant before infringing upon an individual’s reasonable expectation of privacy. Several courts have held that patients have no reasonable expectation of privacy, or a severely diminished expectation of privacy, in their prescription drug records held in PDMPs. As support, courts rely on the third-party doctrine because the information is disclosed to physicians and then held by the state; the highly regulated nature of the prescription drug industry; and the statutory framework of the Controlled Substances Act. Such analysis disregards patients’ expectation of privacy in their personal health information, the confidentiality in the physician-patient relationship, and the resulting patient incentives not to seek care. Therefore, this Article argues that law enforcement must have probable cause and a search warrant to access PDMPs because the exceptions to the Fourth Amendment’s probable cause and warrant requirements do not apply.

中文翻译：

---

处方药监测计划的第四修正案保护：阿片类药物危机中的患者隐私

阿片类药物危机是美国历史上最大的公共卫生问题之一。处方药监测计划（“PDMP”）——包含该州所有受控物质处方记录的州数据库——已成为跟踪阿片类药物处方和使用的一种手段。虽然 PDMP 通常用作医生告知其处方实践的工具，但许多州也允许执法部门在调查受控物质分布时访问 PDMP，通常无需事先获得司法批准。这种对 PDMP 的执法使用引发了严重的患者隐私问题。第四修正案保护个人免受不合理的搜查和扣押，如果他们对隐私有合理的期望，并且被解释为要求执法部门在侵犯个人对隐私的合理期望之前有合理的理由和搜查令。一些法院认为，患者在 PDMP 中保存的处方药记录中对隐私没有合理的期望，或者对隐私的期望严重降低。作为支持，法院依赖第三方原则，因为信息被披露给医生，然后由国家持有；处方药行业的高度监管性质；以及《受控物质法》的法定框架。这种分析无视患者对其个人健康信息隐私的期望，医患关系的保密性，以及由此产生的患者不寻求治疗的动机。因此，本文认为，执法部门必须有正当理由和搜查令才能访问 PDMP，因为第四修正案的正当理由和搜查令要求的例外情况不适用。