[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]

[chimeracoder]

> Well thats the rub, isn't it? Right now the courts don't see this as a violating of the 4th amendment.

You omitted the end of my sentence in your quote, which is operative in this case. As explained in the article, the Third Party Doctrine establishes a loophole in 4th Amendment case law. The system you're describing is one which was created specifically to exploit this loophole: to violate patients' privacy while still complying with the 4th Amendment on technical grounds, all the while grossly violating it in spirit.

[CodeAndCuffs]

> You omitted the end of my sentence in your quote, which is operative in this case.

My apologies. I've re-added it with an edit note.

I think its a reach to say 'the system' was created to exploit 4th amendment loopholes, especially in this case. Again, the patients privacy isn't compromised by the pharmacies at all here. The state has its claim of a vested interest in prescription activity, much like with drivers licenses and vehicle registration, and has a database of said data, much like with licenses and vehicle registration.

If I start running tags to see where someone lives to stalk them, thats bad, and illegal. If I start running prescription data for someone to see what they're on and stalk them, thats bad and illegal.

If a car dealer says "These VINs on the car dont match, we think something was stolen" we can investigate it by accessing the state database. We will likely see some personal information of someone who isnt guilty of anything in the process of this investigation. If a doctor says "This person filled a prescription under my name that I didnt write" we can investigate it by accessing the state database. We will likely see some personal information of someone who isnt guilty of anything in the process of this investigation.

My assertion here isnt "Everything is fine, change nothing". Its "If you're concerned about privacy here, you are looking at the wrong target". Warrant requirements could be reasonable. Whether we get them or not, I think a good start would be auto-redacting Prescription Monitoring Program reports. If Doctor Adams says Bill filled a fraudulent script, because Adams doesnt write for percocet, I shouldnt see every name for every prescription on Adams' report. That should be redacted. Then if I see a script for percocet, which we've established is fraudulent, we then un-redact the "patient" name.

Again, CVS handing me a copy of a prescription that I already know is fake is the least significant issue at hand.

[refulgentis]

I've been here, aka worked at Google and became confused why people didn't trust it, since I now trusted it.

Succinctly:

- you described an _excellent_ process

- the key part is "concerningly sometimes ppl handed me stuff before I identified myself"

- there's nothing you can say or do to alleviate that

Furthering the Google analogy, with intent to clarify:

The Google version of this is "you can have all the data behind 20 locks and and 32 keys and 5 biometric measures and never let human eyes actually see it. Now let's turnover all Google employees. You sure they'll do the same thing?"

(the answer is no, after The Great McKinsey-ification and the corner-cutting and self-justification of lies demonstrated since ChatGPT)

[Zak]

> any more than license checkpoint (which the courts have also ruled isn't a violation)

Personally, I think that was a terrible ruling. Any suspicionless stop and check/investigation/search in a place everyone has a right to be should be treated as an unreasonable search.

The pharmacy records checks you're describing here are based on evidence that would likely hold up as probable cause in court.

[terminous]

In the US, driving checkpoints are only allowed to check for compliance with driving laws only for the driver: drivers license, car registration and insurance, and sobriety of the driver. It is part of what you give up to drive in public roads. But checkpoints can't search passengers or the car, unless something else that is illegal is in plain view.

[Zak]

My understanding of the case law on checkpoints is that it started with inland immigration checkpoints, and similar reasoning got applied to checkpoints meant to catch drunk drivers. I consider it an evisceration of the fourth amendment, as did Justice William J. Brennan when he wrote as much in his dissent.

https://en.wikipedia.org/wiki/United_States_v._Martinez-Fuer...

[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.

[WarOnPrivacy]

>> 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.

I feel a benefit of the doubt costs us little in this instance and I feel we need a familiarity with what responsible policing looks like. To me, the OPs recounting provides that.

Past that, I believe that the widespread bad behavior of other agencies is insufficient reason for mistrust here. And casually using others' bad behavior to justify mistrust - this is something we reasonably criticize police for.

[chimeracoder]

> I feel we need a familiarity with what responsible policing looks like. To me, the OPs recounting provides that.

The point is that nearly every cop you talk to will sound like OP. That doesn't mean anything about the integrity of them or their coworkers; it just means that they're capable of articulating their own behavior in a way that makes them sound reasonable with no context. That's an incredibly low bar, one that nearly every abusive cop will clear.

To repeat what I said in a separate comment: Having worked extensively in this area, I'll be blunt and say that anytime someone who works in law enforcement says that there are no abuses of power in their workplace, that means either they were so oblivious that they never saw abuses that are occurring around them, or they were so mired in the system that they are incapable of recognizing the abuses of power that they themselves are participating in.

> Past that, I believe that the widespread bad behavior of other agencies is insufficient reason for mistrust here.

On the contrary, that's exactly what "systemic abuse of power" means. It means that the bad behavior is so ingrained in the operations of the system that individuals' actions contribute to its operations, whether or not they recognize or even understand it.

[WarOnPrivacy]

And you may well have the right of it.

I'd agree that federal and state LEO serve their govs, unilaterally and universally. They exist to advance the interests of the party in power and campaign contributors.

As a public-of-individuals, our best interests may get occasionally get served by accident but our actual welfare is never, ever, not-ever the primary focus.

All that said, I still avoid Cops Suck as the default. Broadly speaking: The more local the force, the less certain is the system-serving corruption. You can get to a place with an ethical+competent commissioner/chief/sheriff. Under them, officers can be allowed to focus on being ethical+competent. I have personally witnessed this.

Where those officers might exist, I want to be fair.

[_heimdall]

> Past that, I believe that the widespread bad behavior of other agencies is insufficient reason for mistrust here. And casually using others' bad behavior to justify mistrust - this is something we reasonably criticize police for.

The government, and any authority, should be mistrusted. Period.

That doesn't mean they aren't sometimes necessary, or that the lack of trust should turn into fear, but any person or organization on the winning end of a power imbalance should not be trusted. The lack of trust there is what leads to checks and balances, we need systems in place to make sure those with the power can't abuse it even if they wanted to.

The best scenario is that (a) the powerful aren't trusted (2) proper guardrails are in place and (d) the powerful actually do act honestly and the guardrails may slow them down a bit but don't prevent them from doing the job they were given power to do.

[WarOnPrivacy]

> The government, and any authority, should be mistrusted. Period.

I mostly agree with that but we're talking about a response (mine) to a post, by someone who's communicating from the interior of an LEA.

His narrative could be propaganda or false or curated by agenda or unhelpfully incomplete or meaningfully representative. We don't know which of those it is. We do know that communication outside of PR channels is useful, even if we have to heavily qualify it.

And valuable info sometimes comes out of informal channels. We're not gaining anything by crapping on it here.

Past that, we risk nothing by assuming good faith of the OP's post - even if our good faith turns out to be misapplied. No judicial precedence is in play. No hearts are swayed to dark sides. No mass readership is being fed a pregurgitated conclusion. No agenda needles get budged.

In this place and at this time: We are safe letting one LEO-adjacent individual feel - well maybe not welcome but at least a lower level of mob noise. We don't have to put their haunches up by pushing back with everything we have.

[_heimdall]

> In this place and at this time: We are safe letting one LEO-adjacent individual feel - well maybe not welcome but at least a lower level of mob noise. We don't have to put their haunches up by pushing back with everything we have.

Totally agree. This thread did go off the rails quite a bit. My main point wasn't actually even whether any one LEO can or should be trusted, I assume a vast majority of them are in the job with good intentions. My aim was more so at the power structure of any LEA or government in general, they should never be trusted IMO even when we're willing to take the risks of centralizing power for some greater good.

[CodeAndCuffs]

> 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).

This is just 100% false. If im pulling a prescription from a pharmacy its because Doctor Adams told me "I never wrote a prescription for Bill Barnes for percocet, but this state maintained record says that he filled a prescription for percocet at CVS #12345 on main street". That statement alone is enough to get a warrant for said pharmacy records.

[chimeracoder]

> That statement alone is enough to get a warrant for said pharmacy records.

Great, then get a warrant.

The entire reason this story exists is because people are surprised and - rightfully - upset that law enforcement is able to access this information without one.

[WarOnPrivacy]

>> That statement alone is enough to get a warrant for said pharmacy records.

> Great, then get a warrant.

I agree with my whole heart. This is the meat and bone of the discussion.

And an important side note: The assertions "can't access without a warrant" and "can't access at all" need to be clearly distinct at all times. Once the 1st gets translated as the 2nd, the good faith portion of this discussion is lost.

[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.

[dvngnt_]

3hrs seems like a small price to pay for patient privacy

[dwattttt]

Everything is cheap when you aren't the one paying for it.

[hn_acker]

Without a warrant requirement, all patients collectively pay their privacy away without knowing it. Is the collective benefit worth it? (Remember, the "benefit" is the additional harm the government prevents when not constrained by a default warrant requirement, not the total harm the government prevents with and without getting warrants.)

[beenBoutIT]

Our entire system is built around the fundamentally American belief that adults need to obtain permission to consume anything that isn't Alcohol or Tobacco (Unless you're an Indian living on a reservation where alcohol has been banned as well).

American pharmacies take special care to put our full names along with our doctors names and phone numbers just to make sure that nobody gets away with possessing drugs that the aren't allowed to have.

A big country like Iran banning alcohol seems unimaginable until you remember that for whatever reason alcohol is the only thing a big country like America hasn't banned.

[travoc]

At this point, some legitimate patients may find it less concerting to just buy their medicine on the black market and avoid all the surveillance.

[patmorgan23]

Warrants are regularly issued based on electronic filings and phone conferences are they not? Everyone spent an entire year plus doing almost all court processes entirely online/over zoom.

[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.

[_heimdall]

To be fair to the system the OP describes, a doctor who's prescription was forged and the pharmacist who filled it could both he considered harmed when someone fills a bogus script. Both are licensed professionals that have a lot to lose if there is reason to believe they may be involved in writing or selling bad prescriptions.

Given that we've already empowered law enforcement agencies to enforce the law, its reasonable for them to step in here to catch those forging prescriptions and risking direct harm to others' rights. What is unreasonable and the main discussion above is the process of dodging the 4th amendment to investigate these people without a warrant.

[caskstrength]

> To be fair to the system the OP describes, a doctor who's prescription was forged and the pharmacist who filled it could both he considered harmed when someone fills a bogus script. Both are licensed professionals that have a lot to lose if there is reason to believe they may be involved in writing or selling bad prescriptions. Given that we've already empowered law enforcement agencies to enforce the law, its reasonable for them to step in here to catch those forging prescriptions and risking direct harm to others' rights.

IMO desperate person who tries to buy 90 pills of Oxycodone with forged prescription (OP's example) needs help, not a criminal record.

> What is unreasonable and the main discussion above is the process of dodging the 4th amendment to investigate these people without a warrant.

Fully agree with this.

[zoklet-enjoyer]

Agreed. I don't think doctor shopping is as much of a thing as it used to be and that's why there's so much demand for counterfeit oxycodone tablets

[_heimdall]

> IMO desperate person who tries to buy 90 pills of Oxycodone with forged prescription (OP's example) needs help, not a criminal record.

Sure I definitely don't have a strong opinion on this. I don't have nearly enough first hand experience helping someone with a serious drug problem, or dealing with one myself. The debate over the best way to help people in this situation is firmly in the space of one that I'm happy to weigh in on but would heavily lean on those more experienced to share what they've found to work best.

Unrelated to drug charges, I was involved in helping a close relative through a criminal case that was entirely based on the testimony of one individual, with no hard evidence and other witnesses directly refuting the claim. I have very strong opinions about the legal system in general that would land me pretty squarely on the "provide help not a criminal record" in a vast majority of cases. Our legal system is a complete shit show.

[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?