Who is monitoring your prescribing patterns?

By Naveed Saleh, MD, MS | Fact-checked by Jessica Wrubel
Published September 14, 2022

Key Takeaways

  • Prescription drug monitoring programs (PDMPs) are state programs that monitor physicians’ prescribing patterns intended to help prevent misuse of prescription drugs.

  • These programs vary between states. Not all physicians register with a PDMP. Results on their efficacy are mixed—integration is a major issue.

  • For PDMPs to be successful—and helpful to clinicians—their integration and user-friendliness will need to be improved. Further development is needed.

The prospect of having your prescriptions monitored by an outside agency through PDMPs may seem downright Orwellian.

PDMP programs are being scrutinized by many stakeholders for their perceived lack of efficacy. Major concerns include a lack of integration and provider buy-in. How can PDMPs become more efficient and useful for clinicians?

DEA origins

Promoted as a tool to combat prescription-drug misuse, PDMPs are intended to help guide future prescribers, according to proponents.

PDMPs are state-specific databases that record which drugs were dispensed to patients. This information comes from retail pharmacies and dispensing physicians, and includes distribution records for some (or all) controlled substances—including opioids.

Access to PDMPs varies by state, but physicians and pharmacists have access in all states. In all but one state, regulatory boards can pipe in, too. Most states allow law enforcement to check their PDMP.

Early PDMPs were funded by the DEA to aid with regulatory and law-enforcement responsibilities. In many states, PDMPs continue to focus on decreasing misuse or diversion of prescriptions from a law enforcement perspective. Initially, information from PDMPs was not available to public health departments, but that changed with the emergence of the opioid epidemic.

“Utilization of PDMPs as a public health tool has grown with the increase in overdoses related to prescription opioids, improvements in health information technology, and a growing understanding that a robust public health response is necessary to address the opioid overdose epidemic,” the CDC wrote in a white paper.[]

The CDC viewed PDMP technology as “promising,” highlighting potential features that could aid with its utility:

  • All physicians should check a patient’s prescribing patterns before writing any new prescriptions.

  • PDMPs should be actively managed and generate patient alerts proactively.

  • Data should be inputted into the PDMP in real time.

  • Access should be provided to other clinicians working with the physician, such as advanced practice providers.[]


Not all states require physicians to register with PDMPs.

Although these programs are viewed positively by many clinicians, rates of buy-in vary, according to a review published in Current Opinion in Psychiatry.[]

Physicians are more likely to register for PDMPs when they feel patients are at higher risk of prescription drug misuse or diversion. Those who have professional experience with overdose are also more likely to register.

Primary care physicians and pharmacists are more likely to consult PDMPs when patients present with red flags for substance abuse, such as wanting unneeded prescriptions, drug ineffectiveness, frequent bloody noses, bloodshot eyes, slurred speech, and tremors.[]

According to this review, cardiologists were more likely to search PDMPs than oncologists—probably because opioid misuse is a lower priority in patients with terminal illnesses. Emergency medicine physicians used the databases more than surgeons did—likely over concerns of “doctor shopping.”

The debate over PDMPs

Experts have pointed to data demonstrating that PDMPs are ineffective and underdeveloped. Even the CDC, which supports PDMP use, acknowledged their shortcomings.

"Although findings are mixed, evaluations of PDMPs have illustrated changes in prescribing behaviors, use of multiple providers by patients, and decreased substance abuse treatment admissions."


“States have implemented a range of ways to make PDMPs easier to use and access, and these changes have significant potential for ensuring that the utility and promise of PDMPs are realized,” the CDC added.

Authors of the Current Opinion in Psychiatry review cited workflow integration as a major problem with current PDMPs. These systems are untethered from EHRs, and providers in high-risk pain populations are unlikely to use them. Spending extra time querying a PDMP is viewed as burdensome.

Another issue is a lack of delegated access—even though delegated access could boost the application of PDMP data. Broadly speaking, PDMPs need to be simpler and more intuitive.

“PDMPs are generally perceived as necessary and beneficial tools,” the authors stated, “however, they will need to overcome perceived workflow and integration barriers before they are widely utilized by more stakeholders in the medical field.”

The evidence supporting PDMP’s benefits for fatal and non-fatal overdose is mostly inconclusive.

A review published in the Annals of Internal Medicine found low-strength evidence that reduction in fatal overdoses occurred only when provider review was necessary, data was updated frequently, and non-scheduled drugs were monitored.[]

Some studies have demonstrated an increase in heroin overdose after PDMP was implemented. A study published in Public Health Reports in 2019 correlated PDMP records with toxicology reports from overdose deaths in Massachusetts over a 2-year period. It found that the major contributors to these deaths were illicitly made fentanyl and heroin—although prescription opioids were detected in more than 40% of the subjects.[]

These findings may indicate that when patients lose access to prescription opioids, they turn to illicit heroin or fentanyl, which are cheaper according to the NIH and CDC, respectively.

What this means for you

Implementation of PDMPs varies from state to state. Although the technology is promising in terms of identifying prescription patterns, it’s still emerging, with issues including lack of integration into workflow. Integration and ease of use will need to be optimized. Clinicians should stay apprised of further PDMP developments, and keep in mind they will need to register and query databases before prescribing to maximize PDMP effectiveness.

Read Next: COVID-19 stoked the adoption of electronic prescribing, yet issues remain
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