A new federal plan aimed at fighting fentanyl could end up tracking far more than drug abuse — including abortion, pregnancy, and gender-affirming care.
On paper, the Trump administration’s newest anti-drug strategy is about stopping fentanyl deaths. But look closer, and it reveals something much bigger: the outline of a nationwide data-tracking system built on some of the most private information Americans have — prescription records, drug test results, sewage samples, hospital files, license plate scans, and police intelligence.
This roadmap appears in the 2026 National Drug Control Strategy, a 195-page document released in early May. Drug Czar Sara Carter unveiled it on Sean Hannity’s Fox News show, describing it as “a battle cry.” The plan calls for fully funding Homeland Security Task Forces, using artificial intelligence and advanced technology, and merging public health data with public safety systems. It specifically mentions applying “advanced data science” to toxicology reports, sewage testing, electronic medical records, and police seizures.
What the strategy doesn’t do is explain any guardrails. HIPAA — the federal law protecting patient privacy — isn’t mentioned once. There’s no explanation of how personal health information would be safeguarded, and no clear line stopping a system designed to catch fentanyl traffickers from being turned toward abortion care, pregnancy monitoring, gender-affirming treatment, methadone programs, protest movements, or whatever else a future administration decides to go after.
Why Law Enforcement Wants This
For veteran drug investigators, merging health records, police intelligence, and modern analytics into one system makes obvious sense. Derek Maltz, who once ran the DEA’s Special Operations Division and served as the agency’s acting administrator, has long argued that cartels, Chinese chemical suppliers, and money-laundering networks move faster than the government’s scattered response.
“If you wanna connect the dots, you have to collect the dots,” Maltz said.
Maltz speaks often about grieving families, the photo collages of children lost to fentanyl that he brings to public events, and parents who say they were never warned in time to save their kids. He calls this “not a red or blue issue,” but a “red, white, and blue” one. The danger is real — Chinese chemical networks tied to Mexican cartels supply the synthetic drugs that kill tens of thousands of Americans annually. Maltz believes agencies need connected data and modern tools to keep pace with criminal networks that already cross borders, banks, and encrypted apps.
Still, even he admits there are limits to what enforcement alone can do. “We are not going to seize our way out of this problem,” he said. “We are not going to arrest our way out of this problem.”
That admission is exactly why the surveillance side of this strategy matters so much. Fentanyl is genuinely deadly, and investigators do need better resources. But the real question is what happens once the systems built for public health start doubling as tools for law enforcement — with no independent oversight watching how they’re used.
Much of this infrastructure isn’t new — it already exists. Every state maintains a prescription drug database. Police already use nationwide license plate reader networks. Sewage testing expanded during the pandemic. Health records are already used to build risk scores and appear in criminal cases. What the 2026 strategy does isn’t invent these tools — it links them together, and that’s the part that changes everything.
Prescription Records: A System With Almost No Privacy Protection
Every time a doctor prescribes a controlled medication — painkillers, ADHD medication, anti-anxiety drugs, certain hormones — that record lands in a state-run Prescription Drug Monitoring Program, or PDMP. Every state runs one. Unlike most medical records, these databases aren’t protected under HIPAA. Federal drug agents can pull data from any state’s system simply by filing a subpoena — no judge required.
“This is a wild, wild west,” said Jennifer Oliva, an Indiana University law professor who has studied these databases for over a decade.
The federal government actually helped fund these state databases through Justice Department grants, since the DEA had no way to collect prescriber-level data on its own. The opioid epidemic made the funding politically easy to justify — but these systems were never restricted to opioids alone.
“There’s no reason to think that the same mechanisms in place to track and respond to potential opioid misuse can’t be turned to other drugs,” said Corey Davis, senior attorney at the Network for Public Health Law. He added there’s solid evidence that these monitoring programs actually push people from misusing prescription opioids toward street opioids — a shift that makes overdose risk worse, not better. In other words, the tool meant to fix the opioid crisis may have deepened it, and now its reach is expanding.
States have several ways to widen these databases beyond opioids — through controlled-substance scheduling, “drugs of concern” labels, or new reporting rules. Louisiana went furthest in 2024, becoming the first state to classify the abortion medications mifepristone and misoprostol as Schedule IV controlled substances, folding them directly into its drug-monitoring system. Texas and Indiana lawmakers have floated similar reclassification bills, and Idaho has reportedly explored comparable tracking measures.
Testosterone, meanwhile, has been a federally controlled Schedule III steroid — and tracked accordingly — since 1990. But a database entry can’t tell you why someone was prescribed it: low hormone levels or gender transition. The same goes for mifepristone — the record doesn’t distinguish between an abortion and treatment for a miscarriage.
University of Virginia law professor Craig Konnoth called this “a clear example of targeting a vulnerable minority.” Asked if there’s any legal protection against it, his answer was blunt: “Unfortunately, in my opinion, no.”
Artificial Intelligence Is Already Reading Medical Records
A company called Bamboo Health operates a platform, NarxCare, layered on top of these state prescription databases. It assigns patients a risk score using factors like payment method, insurance status, and even how far someone travels to reach a pharmacy. No state requires doctors to disclose that this scoring system exists, and patients have no way to view their own scores.
The 2026 drug strategy wants to take this further, calling for “predictive analytics” applied to electronic health records to flag patients considered high-risk for overdose.
That might sound like a purely medical safeguard. But Charlotte Tschider, a health AI researcher at Loyola Chicago, points out that current regulations don’t separate AI tools meant to help patients from AI tools meant to enforce the law. Nothing legally prevents a system built to spot overdose risk from being repurposed to flag someone getting an abortion pill or starting hormone therapy.
The records feeding these AI systems aren’t the tidy clinical notes most people picture — they’re billing paperwork. Dr. Mishka Terplan, an OB/GYN and addiction medicine specialist, offered an example: a pregnant patient tests positive for drugs once, at her very first prenatal visit, and never again. Her file still gets stamped with the billing code “drug abuse complicating pregnancy” — even though “complicating” in this context just means the two things happened at the same time, not that drugs caused any harm. In court, however, a judge may read that code as proof of wrongdoing.
What Your Sewage Says About You
Equity Partners — led by Antonio Gracias, a major Trump donor and former DOGE official — and the company Biobot hold a January 2026 wastewater-intelligence contract with the Office of National Drug Control Policy. When asked directly about it, a representative didn’t answer the question, but instead offered to “educate” law enforcement on integrating wastewater intelligence.
Rolf Halden, an Arizona State University scientist who built the first citywide wastewater drug-monitoring program in the U.S., confirmed independently that nearly any medication or its breakdown products can be detected through sewage testing. His lab has also fielded requests about testing for abortion medications.
According to Halden, what currently protects individuals from being personally identified through this method isn’t any privacy law — it’s simply the high cost of doing it at scale, for now.
The CDC’s National Wastewater Surveillance System, built during the COVID pandemic, runs on a $443 million contract with Palantir’s Foundry software. The CDC has said funding for the program is set to run out after September 30, 2026. Meanwhile, lawmakers in several states have introduced bills that would require sewage testing specifically for abortion-related medications.
University of Maryland law professor Natalie Ram and Emory law professor Jessica Roberts warned that if wastewater testing for mifepristone succeeds, it “would create a roadmap for surveilling, suppressing, and sanctioning other politically contested medical care.”
Connecting Every Data Point
Each piece of this system reveals something different. Prescription databases show what medications people receive. Electronic health records reveal what doctors document and bill for. Wastewater testing shows what entire communities consume. License plate readers show where people physically travel.
The drug strategy also draws on six overlapping federal license-plate-reader networks that Congress never formally authorized. Nothing currently stops these networks from tracking a car driving to an abortion clinic or a methadone treatment center.
“Under the current way that law enforcement uses these systems, absolutely nothing stops that kind of abuse,” said Nathan Wessler, an ACLU attorney who has argued surveillance cases before the Supreme Court.
An investigation by the Electronic Frontier Foundation found Texas deputies using a nationwide plate-reader network to search for a woman who had undergone a self-managed abortion. Both searches in that case were logged under the label “had an abortion, search for female.”
Each of these tracking systems is typically reviewed on its own, if it’s reviewed at all. Almost no one is examining what happens once all of them feed into the same law enforcement task forces.
NYU law professor Barry Friedman put it plainly: “No oversight. None.”
This surveillance system has no special court reviewing it, no expiration date, and no congressional debate behind it — not even the limited safeguards that apply to counterterrorism surveillance under the Foreign Intelligence Surveillance Act. And increasingly, the line between “drug enforcement” and “counterterrorism” is disappearing.
A Familiar Contractor at the Center of It All
The company best positioned to run this combined system is already deeply embedded in federal health agencies. The Department of Health and Human Services has a contract worth up to $90 million that makes Palantir’s software available across the department. HHS Chief Information Officer Clark Minor, who oversees the department’s health data systems, spent more than a decade working at Palantir before joining the government.
Financial disclosures show Minor held between $1 million and $5 million in Palantir stock for over five months after taking his government position, before eventually selling it. Separately, a transaction report signed May 8, 2026, shows President Trump made six-figure purchases of Palantir stock, while his administration has awarded the company more than $1 billion in federal contracts.
The concern here isn’t simply that one company holds government contracts — plenty of companies do. It’s that the government is building out connected data infrastructure at scale while setting almost no boundaries around medical privacy, law enforcement access, or the risk of political misuse.
Is Anything Actually Off-Limits?
The administration’s 2026 Counterterrorism Strategy, released the same month, formally labels fentanyl and its precursor chemicals as “Weapons of Mass Destruction.” That single classification merges drug enforcement with counterterrorism policy — unlocking the broader, more powerful surveillance authorities that come with a WMD designation.
“There’s a tremendous danger that you have the executive branch throwing together a whole bunch of stuff in an attempt to look tough,” Wessler said. “And it will be years potentially before judges are able to get involved.”
Maltz sees this integration as fundamentally about public safety. He argues that law enforcement and intelligence agencies have long needed systems that connect data gathered under court-approved warrants, so investigators can map out criminal networks instead of drowning in disconnected files. “The data sets that these agencies are receiving from the providers pursuant to court orders and search warrants and things like that, it’s a tidal wave of data,” he said. “It’s impossible to go through it without having robust technology tools.”
But health information isn’t just another stream of intelligence data. It’s created every time someone visits a doctor, fills a prescription, gets screened during pregnancy, takes medication, seeks addiction treatment, drives to a clinic, or simply lives in a community whose sewage happens to get tested. Once all of that gets fused with law enforcement and counterterrorism tools, the real question stops being whether the system can find someone — it becomes whether there’s anything at all it isn’t allowed to look for.
Some people inside the drug enforcement world argue the fix is stronger oversight, not less technology. Maltz insists the U.S. is falling behind increasingly sophisticated criminal networks and needs modern tools to save lives. But privacy and public health experts see something different: a surveillance system being built with essentially no rules about what it can do, and no ceiling on what it could eventually be used for.
Oliva described a system that could realistically track almost anyone. “You can get anybody with all of them for sure,” she said, “no matter how off the grid they think they are.”
Wessler called it “a completely unprecedented look at somebody’s medical history, their movements, their associations.”
The administration has already hinted at who else might end up in its crosshairs. The same counterterrorism strategy that labels fentanyl a weapon of mass destruction also names “violent secular political groups whose ideology is anti-American, radically pro-transgender, and anarchist” as priority targets — right alongside cartels and Islamist terror groups. It promises to use “all the tools constitutionally available” to map these groups, identify their members, and “cripple them operationally before they can maim or kill the innocent.”
Put the two strategies together, and the picture becomes clear: the drug strategy builds the tools — prescription databases tracking testosterone and abortion pills, wastewater testing that can detect hormones, AI scanning medical records, and license plate readers watching where people drive. The counterterrorism strategy names the targets and authorizes acting before anything even happens.
Oliva offered perhaps the starkest warning of all: “Just pick something that they’ve decided, that MAHA [‘Make America Healthy Again’] has decided is bad tomorrow, despite all the scientific evidence, boom.” The HPV vaccine. mRNA vaccines. Tylenol. Hormones. Stem cell therapies. “It never ends. It just continues.”