Doctors and pharmacists make critical decisions every day about whether to dispense opioids that alleviate pain but fuel addiction. Faced with a drug crisis that has already claimed more than a million lives, legislatures, courts, and policymakers have enlisted the help of technology in the hopes of curtailing prescriptions and preventing deaths. This book reveals how this “Trojan horse” technology embeds the logics of surveillance in the practice of medicine, forcing care providers to police their patients while undermining public trust and doing untold damage to those at risk.
Elizabeth Chiarello draws on hundreds of in-depth interviews with physicians, pharmacists, and enforcement agents across the United States to take readers to the frontlines of the opioid crisis, where medical providers must make difficult choices between treating and punishing the people in their care. States now employ prescription drug monitoring programs capable of tracking all controlled substances within a state and across state lines. Chiarello describes how the reliance on these databases blurs the line between medicine and criminal justice and pits pain sufferers against people with substance-use disorders in a zero-sum game.
Shedding critical light on this brave new world of healthcare, Policing Patients urges medical providers to reaffirm their roles as healers and proposes invaluable policy solutions centered on treatment, prevention, and harm reduction.
Elizabeth Chiarello is associate professor of sociology at Saint Louis University, a former fellow at the Harvard Radcliffe Institute, and a frequent public commentator on opioid-related topics. She and her work have been featured in USA Today and on Bloomberg News, among other leading media outlets. Her work is supported by the National Science Foundation.
"Gripping. . . . Chiarello doesn’t flinch from the complexities of the story she tells."—Sarah Fenske, St. Louis Magazine
“In Policing Patients, Elizabeth Chiarello eloquently and clearly outlines how policing and surveillance technology have become bound up with healthcare practices under the auspices of addressing the overdose crisis. Chiarello highlights the stakes of this for frontline workers such as pharmacists, prosecutors, investigators, and physicians and reveals the pervasive cultural logics embedded in our intersecting yet conflicting responses to addiction and pain.”—Kimberly Sue, MD, PhD, author of Getting Wrecked: Women, Incarceration, and the American Opioid Crisis
“In this ambitious account of the law in action, Elizabeth Chiarello reveals how frontline workers act as gatekeepers over how and whose pain is treated in America and how surveillance tools have transformed medical judgments that should be wholly independent of criminal justice considerations. Policing Patients is a major contribution that demonstrates how efforts to combat the opioid crisis have inadvertently produced punitive imperatives in professions that should be dedicated to care.”—Jonathan Simon, author of Mass Incarceration on Trial: A Remarkable Court Decision and the Future of Prisons in America
“In this wide-ranging study, Elizabeth Chiarello draws on more than a decade of research and hundreds of interviews to take readers behind the pharmacy counter, into doctors’ offices, and within law enforcement agencies. Policing Patients is a powerful examination of the opioid crisis and surveillance technologies through the lens of frontline work.”—Sarah Brayne, author of Predict and Surveil: Data, Discretion, and the Future of Policing
“Chiarello shows, in devastating detail, how prescription drug surveillance databases inhibit pharmacists and other healthcare workers in their primary roles as care providers. Policing Patients gives a renewed understanding of the importance of patient-centered public health and the need to deemphasize and dismantle punitive structures in healthcare.”—Jeffrey Bratberg, PharmD, FAPhA, University of Rhode Island College of Pharmacy
