In response to federal financial incentives and mandates, all fifty states, the District of Columbia, and three U.S. territories administer electronic prescription drug monitoring programs (PDMPs).  Federal and state policymakers justified the implementation and enhancement of ubiquitous prescription drug monitoring by contending that expansive state drug surveillance was a necessary weapon in the war against the American drug overdose crisis.  As is often the case with tools designed for law enforcement surveillance, however, PDMPs have proven susceptible to mission creep.  Although pioneer PDMPs were paper-based systems that limited their surveillance to a narrow class of heavily regulated controlled substances, modern PDMPs are powered by sophisticated, algorithm-driven software platforms.  Most state PDMPs have the authority to monitor all controlled substances as well as noncontrolled “drugs of concern.”  Modern PDMPs also share their voluminous, sensitive health information across state lines.  This Essay argues that the need for legal reform of these dragnet state prescription monitoring systems is urgent given the ongoing attack on medication abortion and gender-affirming care as well as the heightened policing of pregnancy behaviors post-Dobbs v. Jackson Women’s Health Organization.