Challenging Disability Discrimination in the Clinical Use of PDMP Algorithms

Abstract

State prescription drug monitoring programs (PDMPs) use proprietary, predictive software platforms that deploy algorithms to determine whether a patient is at risk for drug misuse, drug diversion, doctor shopping, or substance use disorder (SUD). Clinical overreliance on PDMP algorithm-generated information and risk scores motivates clinicians to refuse to treat-or to inappropriately treat-vulnerable people based on actual, perceived, or past SUDs, chronic pain conditions, or other disabilities. This essay provides a framework for challenging PDMP algorithmic discrimination as disability discrimination under federal antidiscrimination laws, including a new proposed rule interpreting section 1557 of the Affordable Care Act.

Keywords: ACA; ADA; Americans with Disabilities Act; PDMPs; algorithmic discrimination; clinical algorithms; clinical ethics; disability discrimination; section 1557 of the Affordable Care Act; substance use disorder.