When my two oldest daughters were lightning-fast toddlers, my ex-wife and I used to take them to Myrick Park in La Crosse, Wis. We loved that place because the playground was built like a medieval castle, with turrets, tunnels, and hidden corners. Kids went wild for it, and ours were no exception.
We’d each shadow one daughter, not so close that we’d spoil their fun, but not so far that we couldn’t sprint if things went sideways. It was its own kind of cardio workout, just keeping up.
They were blurs, darting, climbing, vanishing around corners. On one of those castle-chase afternoons, I remember one of them zipping off with supernatural speed.
I shifted to keep pace, angled behind her, took a hard step to my left, and...
WHAM.
Darkness.
No, I didn’t black out. My baseball cap just slammed into a low crossbeam and got shoved over my eyes, probably for the best. I like to think I have a pretty decent pain tolerance, but this one was a full-body jolt. It rang my bell.
I did everything in my power to walk calmly to a bench, sit down, and quietly whimper without attracting attention.
So what’s the point of this story?
That WHAM is exactly how it felt when I got blindsided by my insurance company. Out of nowhere, a pain medication that had been working, Nucynta, was yanked from the approved list. No heads-up. No reason. No fallback plan. Just gone.
And that’s when I met the invisible wizard behind the curtain: Wisconsin’s Enhanced Prescription Drug Monitoring Program.
A System Built With Good Intentions
The Wisconsin Enhanced Prescription Drug Monitoring Program (ePDMP) was born of genuine concern. It was launched in 2017 as a proactive measure to curb the misuse of opioids and other controlled substances.
As overdoses swept the country, state legislators and medical boards leaned into surveillance tools like the ePDMP, hoping that better data would yield better judgment.
In theory, it was a logical step: give healthcare providers access to real-time prescribing data to identify red flags, such as doctor shopping, overlapping prescriptions, and early refills.
- Physicians must consult this database before prescribing.
- The database offers integration with electronic health record (EHR) systems to streamline processes.
- The database provides "peer comparison" metrics, allowing doctors to see how their prescribing habits align with those of their peers in the same field.
It all sounded smart. Forward-thinking. Tech-enabled. Ethical, even.
But in practice, it has quietly left behind a swath of patients the system wasn’t built to accommodate: those with chronic and long-term pain. Their stories aren’t being told nearly enough.
From Guardian to Gatekeeper
The ePDMP was supposed to serve as a safeguard, not a gatekeeper. Yet for chronic pain sufferers, it has increasingly acted as a barrier between them and the medications that help them function.
Providers, once trusted to exercise clinical judgment, are now under a microscope. They know that writing too many prescriptions for opioids or high-risk medications like gabapentin (newly added to Wisconsin's ePDMP list in May 2025) could flag them as outliers.
Even with no harmful outcomes, the mere appearance of deviation can trigger audits, disciplinary action, or worse.
Rather than risk their license or reputation, many physicians are cutting patients off.
Or they’re tapering doses to ineffective levels without consultation.
Or they simply refuse to prescribe altogether, redirecting patients to pain management clinics already overwhelmed or restricted by the same policies.
The result is a slow-motion medical abandonment of a vulnerable population. Patients with debilitating conditions like failed back surgery syndrome, rheumatoid arthritis, advanced neuropathy, or Ehlers-Danlos Syndrome find themselves boxed out of the very treatments they were once stabilized on.
Often, these patients aren’t new to opioids. They’ve taken them responsibly for years. But the program doesn’t account for that nuance.
Risk Scores, Red Flags, and Robotic Medicine
Part of the issue is that the ePDMP is increasingly driven by automation and risk metrics.
Tools like NarxCare are used to calculate "risk scores" for patients based on their prescription histories, pharmacy usage, and other opaque criteria. These scores then influence whether providers feel comfortable writing a script.
This is where the system truly breaks down. The algorithm doesn’t know whether a patient is a Navy veteran with severe spinal trauma.
It doesn’t factor in a failed fusion surgery that left someone unable to sleep without pain meds.
It can’t differentiate between someone abusing the system and someone with three valid specialists managing care.
But many doctors, already time-strapped, simply glance at the score. If it’s high, they defer. If the system throws up a red flag, even for a legitimate refill, it’s easier to say "no" than to take the risk.
Chronic pain patients are being turned into data points and risk liabilities.
They're not being heard, examined, or believed.
A National Problem With Local Faces
Wisconsin is hardly alone in this. All 50 states now have PDMPs, and many of them use them similarly. But the difference lies in how rigidly they’re enforced and how little room is left for medical discretion.
In some states, PDMP checks are only required in certain circumstances. In Wisconsin, prescribers must check the ePDMP before issuing any monitored prescription unless the situation qualifies for one of a narrow list of exemptions (hospice care, direct hospital administration, etc.).
Wisconsin’s decision to include gabapentin, a drug with increasing scrutiny from off-label abuse but also used widely for legitimate chronic pain and seizures, sends a signal.
The net is widening, and chronic pain patients are again caught in the drag.
And then there’s the ripple effect: pharmacists, too, are bound by the ePDMP. If a pharmacist sees a red flag, they can refuse to fill a prescription.
No appeal.
No override.
No humanity.
Treated Like Criminals
A painful irony is emerging: while the original goal of PDMPs was to stop criminal abuse of prescription drugs, the ones most scrutinized today are often the least criminal.
Chronic pain patients, many elderly, disabled, or veterans, now live with the constant fear that next month’s refill will be denied.
Some have been accused outright of "doctor shopping" for having multiple providers despite having referrals and records to prove otherwise.
Others are dropped after one missed appointment or an insurance issue that causes their prescriptions to be transferred to a different pharmacy.
The trauma of untreated pain is real. But so is the humiliation of being treated like a suspect every time you walk into a clinic or pharmacy.
Chilling Effects on Providers
Doctors, too, are casualties of this system. Pain specialists and even general practitioners are leaving the field or discontinuing chronic pain treatment altogether.
Some cite the stress of working under constant surveillance. Others fear losing their license over one flagged patient encounter.
The ePDMP's peer comparison metrics are particularly insidious. Imagine being told you prescribe more pain medication than 90% of your peers with no consideration of your specialty, patient population, or regional needs.
Many prescribers respond by cutting back across the board, regardless of individual cases.
And who fills that vacuum?
Often, no one. Pain clinics have months-long waits. Insurance may not cover alternatives, such as physical therapy or spinal cord stimulators.
Chronic pain patients are left in limbo.
Where the System Can Be Fixed
No one is calling for a return to the Wild West of overprescribing. But the pendulum has swung too far. A few targeted reforms could make a world of difference:
- Transparency in Risk Scores: Patients should have access to their NarxCare scores and be allowed to contest errors or contextless red flags.
- Medical Review Boards with Balance: Audits and reviews should include pain management experts who understand complex, long-term cases, ensuring a comprehensive approach.
- Tapering Protocols with Oversight: Forced or abrupt tapering should be banned. Any reduction plan should be medically supervised and patient-centered.
- Provider Protection: Physicians who act in good faith and follow best practices should not be penalized for treating pain responsibly.
- Restoring the Doctor-Patient Relationship: The ePDMP should support informed decision-making, not override it.
The Actual Risk
There is a risk in treating pain. But there is also a profound risk in ignoring it. The CDC’s own 2022 guidelines emphasized that opioids, when used responsibly, remain a legitimate option for many patients. Yet the fear built by ePDMPs has already taken deep root.
We cannot afford to let an algorithm replace human judgment. Nor can we accept a system that punishes people for being sick, in pain, or unlucky enough to live in a data-driven age where context has been stripped from care.
If Wisconsin’s ePDMP is to live up to its ideals, it must learn to see not just statistics but people. It is essential to understand that not every red flag shows abuse.
Sometimes, it’s a flare, a cry for help.
And in a state that once prided itself on innovation and care, it’s time we stop treating our most vulnerable liabilities and start seeing them as neighbors, patients, and people again.
