429 U.S. 589 (1977)
In August 1970 the New York Legislature created a special commission to evaluate the State’s drug-control laws after determining that drugs with both legitimate and illegitimate uses were being diverted into unlawful channels.1 The commission found existing laws deficient because there was no effective way to prevent stolen or revised prescriptions, repeated refills by unscrupulous pharmacists, patients obtaining prescriptions from multiple doctors, or doctors over-prescribing.2
The 1972 New York State Controlled Substances Act classified potentially harmful drugs into five schedules and placed the most dangerous legitimate drugs, including opium derivatives, cocaine, methadone, amphetamines, and methaqualone, in Schedule II.3 With an exception for emergencies, the Act requires every Schedule II prescription to be written in triplicate on an official form that identifies the prescribing physician, the dispensing pharmacy, the drug and dosage, and the patient’s name, address, and age; one copy must be forwarded to the New York State Department of Health in Albany.4
Approximately 100,000 Schedule II prescription forms arrive at the Department of Health each month, where they are sorted, coded, logged, and recorded on magnetic tapes for computer processing before being returned to a vault for five-year retention and eventual destruction.5 The receiving room is protected by a locked wire fence and alarm system, computer tapes are stored in a locked cabinet, the computer runs off-line with no external terminals, and public disclosure of patient identities is prohibited by statute and regulation with willful violations punishable by up to one year in prison and a $2,000 fine.6
At the time of trial, seventeen Department of Health employees had access to the files. Twenty-four investigators were authorized to investigate cases of apparent overuse. After twenty months of operation the computerized data had been used in only two investigations.7 A few days before the Act became effective, patients who regularly received Schedule II prescriptions, doctors who prescribed such drugs, and two physicians’ associations commenced this litigation challenging the patient-identification provisions.8
After an initial dismissal that was reversed by the Court of Appeals for the Second Circuit, a three-judge District Court conducted a one-day trial. Appellees introduced evidence that some patients declined needed Schedule II medication because of fear that the computerized records would stigmatize them as drug addicts. Two parents had taken a child off such medication for that reason. Three adult patients feared disclosure, with one now obtaining drugs out of state.9
Four physicians testified that patients reacted with shock and concern when informed of the central filing system and that one doctor had stopped prescribing Schedule II drugs altogether, although more than 100,000 such prescriptions continued to be filled each month without reported objections reaching the District Court.10 The District Court enjoined enforcement of the patient-identification provisions of the Act.11
Whether the State of New York may record, in a centralized computer file, the names and addresses of all persons who have obtained Schedule II drugs pursuant to a doctor’s prescription without violating constitutionally protected rights of privacy?12
The cases sometimes characterized as protecting privacy have in fact involved at least two different kinds of interests: the individual interest in avoiding disclosure of personal matters and the interest in independence in making important kinds of decisions.13 A statute does not violate these interests unless it poses a sufficiently grievous threat to either.14
Yes. The New York program does not pose a sufficiently grievous threat to the interest in avoiding disclosure of personal matters. The security provisions are adequate. The remote possibility of improper administration or evidentiary use does not invalidate the statute on its face.15
The New York program does not, on its face, pose a sufficiently grievous threat to either interest to establish a constitutional violation.16
Related opinions on this issue
Justice Brennan wrote separately to express his understanding that the interest in avoiding disclosure of personal matters is an aspect of the right of privacy. He holds that in this case any such interest has not been seriously enough invaded by the State to require a showing that its program was indispensable.17 The information disclosed by the physician under this program is made available only to a small number of public health officials with a legitimate interest in the information.18 Broad dissemination by state officials of such information would clearly implicate constitutionally-protected privacy rights and would presumably be justified only by compelling state interests.19
Justice Brennan found the safeguards in the central computer storage sufficient to prevent abuse in this case. The State’s carefully designed program includes numerous safeguards intended to forestall the danger of indiscriminate disclosure.20
Justice Stewart concurred to make clear that although the Constitution affords protection against certain kinds of government intrusions into personal and private matters, there is no general constitutional right to privacy.21 The protection of a person’s general right to privacy is left largely to the law of the individual States.22 Justice Stewart explained that Griswold v. Connecticut does not recognize a general interest in freedom from disclosure of private information. The holding related to marriage, privacy in the home, and the right to use contraceptives.23
Justice Stewart further explained that Stanley v. Georgia does not recognize a general interest in freedom from disclosure of private information. The holding was simply that the First Amendment protects a person’s right to read what he chooses in circumstances where that choice poses no threat to the sensibilities or welfare of others.24
Whether New York’s patient-identification requirements for Schedule II prescriptions impermissibly interfere with patients’ independence in making important health care decisions?25
The interest in independence in making important kinds of decisions is protected by the Fourteenth Amendment. A statute does not violate this interest when it leaves the decision to prescribe or use medication entirely to the physician and the patient within dosage limits. It does not condition access on the consent of any state official or other third party.26
No. The statute did not deprive the public of access to the drugs. About 100,000 prescriptions for Schedule II drugs were being filled each month prior to the injunction.27 The decision to prescribe or to use the medication is left entirely to the physician and the patient within dosage limits that appellees do not challenge.28
The patient-identification requirements do not impermissibly interfere with patients’ independence in making important health care decisions.29
Whether the statute unconstitutionally impairs physicians’ right to practice medicine free from unwarranted state interference?30
A physician’s claim that a statute impairs the right to practice medicine free from unwarranted state interference is derivative from the patients’ claim. Therefore the claim is no stronger than the patients’ claim when it rests on the possibility that patients’ concern about disclosure may induce them to refuse needed medication.31
No. The doctors’ claim is derivative from the patients’ claim. To the extent it references the possibility that patients’ concern about disclosure may induce refusal of needed medication, the doctors’ claim is no stronger than the patients’ claim which the court rejected.32
The statute does not unconstitutionally impair physicians’ right to practice medicine free from unwarranted state interference.33