Prescription drug monitoring programs (PDMPs)

Evidence Rating

Strategies with this rating are likely to work, but further research is needed to confirm effects. These strategies have been tested more than once and results trend positive overall.

Disparity Rating

No impact on disparities likely

Community Conditions

Alcohol and drug use

Societal Rules

Institutional practices

Authors

Lead: Bomi Kim Hirsch

Contributor(s): Alison Bergum, Jessica Rubenstein

Acknowledgements: Kate Austin Stanford, Kiersten Frobom

Date Last Updated

March 17, 2017

Prescription drug monitoring programs (PDMPs) are electronic databases, housed in state agencies, that track prescribing and dispensing of controlled substances. Most states monitor drugs on Schedules II - IV of the Drug Enforcement Administration’s drug schedule; many also include drugs on Schedule V and other controlled substances. Schedule I drugs (e.g., heroin) are not included. PDMPs can be used by prescribers and pharmacists to view prescriptions written for and dispensed to individual patients, by law enforcement agencies to identify drug diversion or pill mills, or by state medical boards to identify potentially problematic prescribers. Drugs monitored, individuals authorized to use the system, functionality, and use varies from state to state (CDC-PDMPs).

What could this strategy improve?

Expected Benefits

Our evidence rating is based on the likelihood of achieving these outcomes:

Increased appropriate drug prescribing
Reduced overdose deaths

Potential Benefits

Our evidence rating is not based on these outcomes, but these benefits may also be possible:

Reduced illicit drug use
Increased substance use disorder treatment

What does the research say about effectiveness? -+

There is some evidence that prescription drug monitoring programs (PDMPs) reduce the amount and number of drugs prescribed, particularly opioids (Fisher 2012a, Rasubala 2015, Simoni-Wastila 2012, Chang 2016, Rutkow 2015a). PDMPs can also reduce opioid overdose deaths (Patrick 2016, Pardo 2017, Delcher 2015, CDC MMWR-Johnson 2014). However, additional evidence is needed to confirm effects.

States with PDMPs appear to have smaller increases in opioid misuse (Reifler 2012) and opioid-related hospital admissions per year than states without PDMPs (Reifler 2012, Reisman 2009). States with PDMPs also appear to slow the increase in supply of prescription pain relievers and stimulants (Reisman 2009, Simeone 2006). Opioid death rates are lower in states with more robust PDMPs than states with weaker PDMPs (Pardo 2017).

An assessment of New York’s mandatory PDMP indicates that 78% fewer opioid pills were prescribed in a dental urgent care center during the 3-months after implementation (Rasubala 2015). Combined with other efforts to regulate prescribing and dispensing, Florida’s PDMP has been shown to reduce the number of opioid prescriptions among high-volume prescribers (Chang 2016, Rutkow 2015a) and reduce diversion of prescription opioids (Surratt 2014). An Indiana-based assessment of PDMPs in pharmacy practice indicates that pharmacists who always use a PDMP are more likely to refuse to dispense opioids than pharmacists who never do (Norwood 2016a).

Physicians who use PDMPs during patient visits in Emergency Departments (EDs) appear to alter prescribing decisions, decreasing or eliminating opioids with indications of drug seeking behavior and increasing them when there are no indications of such behavior (Weiner 2013, Baehren 2010). ED providers also report feeling more comfortable prescribing controlled substances when they receive information from PDMPs (McAllister 2015). PDMPs may help confirm physician suspicion of prescription drug misuse (Sowa 2014). Providers who identify suspicious medication behavior can respond clinically, making referrals to mental health or substance abuse treatment (Green 2012, Irvine 2014), and, overall, appear unlikely to pursue legal interventions (Green 2012).

PDMPs can reduce doctor shopping among patients (Pradel 2009, CDC Vital Signs-Opioids). One year after New York and Tennessee required providers to use PDMPs before prescribing painkillers, for example, there were large decreases in the percentage of patients seeing multiple providers to obtain the same drug (CDC Vital Signs-Opioids).

Prescribers are more likely to use PDMPs that present data in real time, are used by all prescribers, and actively identify potential problems such as multiple prescribers or multiple prescriptions (CDC Vital Signs-Opioids). Researchers recommend that PDMPs also be easy to access and use, accessible across states, open to all prescribers to register, include mandatory pharmacy reporting and regular evaluation, and require use in EDs. Systems should contain standardized content and monitor prescription of all drugs in Drug Enforcement Administration (DEA) Schedules II to V, as well as other drugs of concern (CDC-Promising PDMP, Perrone 2012, Greenwood-Ericksen 2016).

Implementation Examples -+

As of June 2020, 49 states and Washington, D.C. have legislation supporting operational prescription drug monitoring programs (PDMPs); Missouri has not enacted legislation (PDMP TTAC). As of July 2019, 43 states and Washington, D.C. require prescribers to register with the PDMP and 45 states mandate reviewing it in specified circumstances (PDMP TTAC).

PDMPs are most often administered by boards of pharmacy, departments of health, law enforcement, and professional licensing (PDMP TTAC). Common methods for funding PDMPs include federal grants such as the Harold Rogers Prescription Drug Monitoring Program, private/non-federal grants, state general revenue funds, controlled substances registration fees, professional licensing fees, and health insurers’ fees (BJA-PDMP grant, CRS-PDMP 2018).

Many states allow access to PDMP data across state lines using the National Association of Boards of Pharmacy’s PMP InterConnect (AHRQ HCIE-Catizone). As of July 2019, 47 states and Washington, D.C. share data with authorized users in other states (PDMP TTAC).

Implementation Resources -+

AHRQ HCIE-Catizone - Catizone CA. System gives authorized users access to interstate information on controlled substance prescriptions, assisting them in identifying cases of potential misuse. Rockville: AHRQ Health Care Innovations Exchange (HCIE).

CDC-Prescription drug abuse state laws - Centers for Disease Control and Prevention (CDC). Prescription drugs: State laws on prescription drug misuse and abuse.

NAMSDL-PDMPs - National Alliance for Model State Drug Laws (NAMSDL). Prescription drug monitoring programs (PDMPs).

NASCSA - National Association of State Controlled Substances Authorities (NASCSA). Prescription Drug Monitoring Programs.

PDMP TTAC - Prescription Drug Monitoring Program Training and Technical Assistance Center (PDMP TTAC). Increase PDMP efficiencies and provide best practices.

RHIhub-Rural PDMP - Rural Health Information Hub (RHIhub). Rural prevention and treatment of substance use disorders toolkit: Prescription drug monitoring programs (PDMP).

Citations -+

* Journal subscription may be required for access.

Baehren 2010* - Baehren DF, Marco CA, Droz DE, et al. A statewide prescription monitoring program affects emergency department prescribing behaviors. Annals of Emergency Medicine. 2010;56(1):19–23.e1–3.

BJA-PDMP grant - U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Assistance (BJA). Harold Rogers Prescription Drug Monitoring Program.

CDC MMWR-Johnson 2014 - Johnson H, Paulozzi L, Porucznik C, et al. Decline in drug overdose deaths after state policy changes: Florida, 2010–2012. Morbidity and Mortality Weekly Report (MMWR). 2014;63(26);569-574.

CDC Vital Signs-Opioids - CDC Vital Signs. Opioid painkiller prescribing. Atlanta: Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC). 2014.

CDC-PDMPs - Centers for Disease Control and Prevention (CDC). Prescription Drug Monitoring Programs (PDMPs).

CDC-Promising PDMP - Centers for Disease Control and Prevention (CDC). What states need to know about prescription drug monitoring programs (PDMPs): Promising PDMP features.

Chang 2016 - Chang H-Y, Lyapustina T, Rutkow L, et al. Impact of prescription drug monitoring programs and pill mill laws on high-risk opioid prescribers: A comparative interrupted time series analysis. Drug and Alcohol Dependence. 2016;165:1-8.

CRS-PDMP 2018 - Sacco LN, Duff JH, Sarata AK. Prescription Drug Monitoring Programs. Congressional Research Service (CRS): 2018.

Delcher 2015* - Delcher C, Wagenaar AC, Goldberger BA, Cook RL, Maldonado-Molina MM. Abrupt decline in oxycodone-caused mortality after implementation of Florida’s Prescription Drug Monitoring Program. Drug and Alcohol Dependence. 2015;150:63-68.

Fisher 2012a* - Fisher J, Sanyal C, Frail D, Sketris I. The intended and unintended consequences of benzodiazepine monitoring programmes: A review of the literature. Journal of Clinical Pharmacy and Therapeutics. 2012;37(1):7–21.

Green 2012* - Green TC, Mann MR, Bowman SE, et al. How does use of a prescription monitoring program change medical practice? Pain Medicine. 2012;13(10):1314–23.

Greenwood-Ericksen 2016* - Greenwood-Ericksen MB, Poon SJ, Nelson LS, Weiner SG, Schuur JD. Best practices for prescription drug monitoring programs in the emergency department setting: Results of an expert panel. Annals of Emergency Medicine. 2016;67(6):755-764.e4.

Irvine 2014 - Irvine JM, Hallvik SE, Hildebran C, et al. Who uses a prescription drug monitoring program and how? Insights from a statewide survey of Oregon clinicians. The Journal of Pain. 2014;15(7):747–55.

McAllister 2015* - McAllister MW, Aaronson P, Spillane J, et al. Impact of prescription drug-monitoring program on controlled substance prescribing in the ED. American Journal of Emergency Medicine. 2015;33(6):781-785.

Norwood 2016a* - Norwood CW, Wright ER. Integration of prescription drug monitoring programs (PDMP) in pharmacy practice: Improving clinical decision-making and supporting a pharmacist’s professional judgment. Research in Social and Administrative Pharmacy. 2016;12(2):257-266.

Pardo 2017* - Pardo B. Do more robust prescription drug monitoring programs reduce prescription opioid overdose? Addiction. 2017.

Patrick 2016 - Patrick SW, Fry CE, Jones TF, Buntin MB. Implementation of prescription drug monitoring programs associated with reductions in opioid-related death rates. Health Affairs. 2016;35(7):1324-1332.

PDMP TTAC - Prescription Drug Monitoring Program Training and Technical Assistance Center (PDMP TTAC). Increase PDMP efficiencies and provide best practices.

PDMP TTAC-WI - Prescription Drug Monitoring Program Training and Technical Assistance Center (PDMP TTAC). Wisconsin state profile.

Perrone 2012 - Perrone J, Nelson LS. Medication reconciliation for controlled substances--an “ideal” prescription-drug monitoring program. The New England Journal of Medicine. 2012;366(25):2341–3.

Pradel 2009* - Pradel V, Frauger E, Thirion X, et al. Impact of a prescription monitoring program on doctor-shopping for high dosage buprenorphine. Pharmacoepidemiology and Drug Safety. 2009;18(1):36–43.

Rasubala 2015 - Rasubala L, Pernapati L, Velasquez X, Burk J, Ren Y-F. Impact of a mandatory prescription drug monitoring program on prescription of opioid analgesics by dentists. PLOS ONE. 2015;10(8):e0135957.

Reifler 2012* - Reifler LM, Droz D, Bailey JE, et al. Do prescription monitoring programs impact state trends in opioid abuse/misuse? Pain Medicine. 2012;13(3):434–42.

Reisman 2009 - Reisman RM, Shenoy PJ, Atherly AJ, Flowers CR. Prescription opioid usage and abuse relationships: An evaluation of state prescription drug monitoring program efficacy. Substance Abuse. 2009;3:41–51.

Rutkow 2015a* - Rutkow L, Chang H-Y, Daubresse M, et al. Effect of Florida’s prescription drug monitoring program and pill mill laws on opioid prescribing and use. JAMA Internal Medicine. 2015;175(10):1642-1649.

Simeone 2006 - Simeone R, Holland L. An evaluation of prescription drug monitoring programs. Simeone Associates, Inc. 2006.

Simoni-Wastila 2012* - Simoni-Wastila L, Qian J. Influence of prescription monitoring programs on analgesic utilization by an insured retiree population. Pharmacoepidemiology and Drug Safety. 2012;21(12):1261–8.

Sowa 2014 - Sowa EM, Fellers JC, Raisinghani RS, et al. Prevalence of substance misuse in new patients in an outpatient psychiatry clinic using a prescription monitoring program. The Primary Care Companion for CNS Disorders. 2014;16(1).

Surratt 2014* - Surratt HL, O’Grady C, Kurtz SP, et al. Reductions in prescription opioid diversion following recent legislative interventions in Florida. Pharmacoepidemiol Drug Safety. 2014;23(3):314–20.

Weiner 2013* - Weiner SG, Griggs CA, Mitchell PM, et al. Clinician impression versus prescription drug monitoring program criteria in the assessment of drug-seeking behavior in the emergency department. Annals of Emergency Medicine. 2013;62(4):281–9.

WI ePDMP - Wisconsin Department of Safety and Professional Services. Wisconsin enhanced Prescription Drug Monitoring Program (WI ePDMP).

WI-Opioid EDs - Wisconsin Chapter American College of Emergency Physicians. Opioids prescribing guidelines for emergency departments and emergency physicians (Opioid EDs). 2016.