Prescription Drug Monitoring Programs: Evolution and Evidence

Overdose deaths from prescription opioids in the U.S. quadrupled from 1999 to 2015, reaching 22,000 in 2015. This increase has been fueled by a dramatic rise in the amount of opioids being prescribed, creating a vast supply of drugs at high risk for misuse. Prescribers, therefore, are a vital link in addressing the current epidemic of overdose deaths and substance use disorders. The challenge is to develop and implement systems that help prescribers identify potential cases of misuse or diversion, while still allowing appropriate prescribing of opioids for pain control.

All states except Missouri now have functioning prescription drug monitoring programs (PDMPs) that collect data from pharmacies on all dispensed controlled substances. These statewide databases have many potential uses: they can help prescribers identify patients who are “doctor-shopping” or who might need substance use disorder treatment; they can help government agencies and medical licensure boards monitor prescribing practices and identify unusual prescribing patterns; and they can inform community-based prevention strategies.

For a PDMP to be effective, however, it must be used. Despite the promise of PDMPs, actual use of PDMPs by prescribers remained low until recent years. A 2014 national survey found that 72 percent of primary care physicians were aware of their state’s PDMP, but only 53 percent of primary care physicians ever used it, and many did not use it routinely. Since then, some states have implemented mandates for provider participation in PDMPs.

This Issue Brief reviews the current status and characteristics of PDMPs, their use, and evidence of their effectiveness. It summarizes best practices for PDMPs and the needs for further research and evaluation.

Current status and characteristics

Not surprisingly, PDMPs have evolved differently across states and over time. Most states provide access to their PDMP to a wide range of health professionals who prescribe or dispense controlled substances, including physicians, nurse practitioners, physician assistants, dentists, pharmacists, and podiatrists. But PDMPs vary considerably in their data collection, processes, and protocols. In a 2015 survey, more than half of states (26) reported that dispensers must submit data daily, while 15 states require weekly input. Fourteen states report some efforts to integrate their PDMP into a health information exchange or electronic health record (EHR). Eighteen states report having an enhanced user interface of some type, such as risk assessment tools or red flags.

One of the key differences is whether a state requires authorized prescribers and dispensers to register/enroll in or use the system. This aspect of PDMPs is rapidly changing; the maps below reflect these differing mandates as of April 2017: