Report to the Subcommittee on 

Oversight and Investigations, 

Committee on Energy and Commerce, 

House of Representatives 

United States General Accounting Office 

GAO

May 2002 PRESCRIPTION 

DRUGS 

State Monitoring 

Programs Provide 

Useful Tool to Reduce 

Diversion 

GAO-02-634 
Page i GAO-02-634 Prescription Drug Monitoring Programs 

Letter 1

Results in Brief 3

Background 4

PDMPs Vary in Objectives, Design, and Operation 9

State Programs Have Helped Shorten Investigation Time and 

Reduced Illegal Drug Diversion 15

Challenges Exist in Establishing and Expanding State PDMPs 17

National Efforts Have Focused on Providing Guidance and 

Technical Assistance 20

Concluding Observations 21

Agency Comments 22

Appendix I Key Features of Selected State Prescription Drug 

Monitoring Programs 23 

Appendix II GAO Contact and Staff Acknowledgments 24 

Tables 

Table 1: Characteristics of State Prescription Drug Monitoring 

Programs 11

Table 2: Key Features of Selected State Prescription Drug 

Monitoring Programs 23

Figure 

Figure 1: Status of Prescription Drug Monitoring Programs, by 

State, April 2002 8

Abbreviations 

DEA Drug Enforcement Administration 

HIPAA Health Insurance Portability and Accountability Act of 1996 

ODC Office of Diversion Control 

PDMP prescription drug monitoring program 

Contents 
Page 1 GAO-02-634 Prescription Drug Monitoring Programs 

May 17, 2002 

The Honorable James C. Greenwood 

Chairman 

The Honorable Peter Deutsch 

Ranking Minority Member 

Subcommittee on Oversight and Investigations 

Committee on Energy and Commerce 

House of Representatives 

The increasing diversion of prescription drugs for illegal use is a disturbing 

trend in the nation’s battle against drug abuse. Prescription drug diversion 

is the channeling of licit pharmaceuticals for illegal purposes or abuse. It 

can involve activities such as “doctor shopping” by individuals who visit 

numerous physicians to obtain multiple prescriptions, illegal sales of 

prescription drugs by physicians or pharmacists, and prescription forgery. 

The most frequently diverted prescription drugs are those that are prone 

to abuse, addiction, and dependence,1

 such as hydrocodone (the active 

ingredient in Lortab and many other drugs), diazepam (Valium), 

methylphenidate (Ritalin), and oxycodone (the active ingredient in 

OxyContin and many other drugs). According to the Drug Enforcement 

Administration (DEA), increases in the extent of prescription drug abuse 

and in emergency room admissions related to prescription drug abuse, as 

well as an increase in the theft and illegal resale of prescription drugs, 

indicate that drug diversion is a growing problem nationwide. In 2000, the 

most recent year for which data are available, about 9 million Americans 

aged 12 and older reported using prescription drugs, including pain 

relievers, tranquilizers, stimulants, or sedatives, for nonmedical purposes.2

The abuse of illegally diverted prescription drugs is associated with 

serious consequences, including addiction, overdose, and death. 

 1

According to the National Institute on Drug Abuse, addiction is a chronic, relapsing 

disease, characterized by compulsive drug seeking and use and by neurochemical and 

molecular changes in the brain, whereas physical dependence is an adaptive physiological 

state that can occur with regular drug use and results in withdrawal symptoms when drug 

use is discontinued. 

2

1999-2000 National Household Survey on Drug Abuse, Substance Abuse and Mental Health 

Services Administration, Department of Health and Human Services. 

United States General Accounting Office 

Washington, DC 20548 
Page 2 GAO-02-634 Prescription Drug Monitoring Programs 

Fifteen states currently operate prescription drug monitoring programs 

(PDMPs) as a means to control the illegal diversion of prescription drugs. 

PDMPs collect, review, and analyze prescription data from pharmacies. 

They provide data and analysis to state law enforcement and regulatory 

agencies to assist in identifying and investigating activities potentially 

related to the illegal prescribing, dispensing, and procuring of prescription 

drugs. Because of your interest in the issues of prescription drug diversion 

and control, you asked us to address the following questions: (1) How do 

the 15 PDMPs compare across states in terms of objectives, design, and 

operation? (2) What benefits have state PDMPs produced? (3) What 

challenges do states face in implementing and using PDMPs? (4) What 

efforts are being made at the national level to address the illegal diversion 

of prescription drugs? 

To address the questions concerning the state PDMPs, we reviewed 

information from DEA and the National Alliance for Model State Drug 

Laws3

 on the features of the existing programs.4 To gain a more in-depth 

understanding of these programs and the challenges they face, we studied 

the PDMPs in Kentucky, Nevada, and Utah. We selected these three 

because they were the most recently established programs. We 

interviewed PDMP administrators and stakeholders in these three states. 

Although the stakeholders varied in each state, they included officials of 

state medical and pharmacy associations, state attorneys general offices, 

state drug enforcement agencies, state police, and a state medical 

examiner’s office. We also spoke with officials from practitioner licensure 

boards and state law enforcement agencies, as well as DEA 

representatives. We also discussed PDMPs with officials from Purdue 

Pharma L.P., the manufacturer of OxyContin and other prescription drugs. 

To determine what activities are being pursued at the national level to 

reduce illegal diversion of prescription drugs, we interviewed experts from 

DEA, the National Alliance for Model State Drug Laws, the National 

Association of State Controlled Substance Authorities, and the Bureau of 

Justice Assistance in the Department of Justice, and reviewed pertinent 

documents. We performed our work from October 2001 through April 2002 

in accordance with generally accepted government auditing standards. 

 3

In this report, we refer to this organization as the Alliance. The Alliance, a nonprofit 

association, is the successor to the President’s Commission on Model State Drug Laws. 

4

All references to state laws relating to PDMPs were provided to us by the National 

Alliance for Model State Drug Laws and were not independently verified. 
Page 3 GAO-02-634 Prescription Drug Monitoring Programs 

All 15 state PDMPs collect information about the prescribing, dispensing, 

and use of prescription drugs and distribute it to medical practitioners, 

pharmacies, and state law enforcement and regulatory agencies, but the 

programs differ in terms of objectives, design, and operations. In addition 

to helping law enforcement identify and prevent prescription drug 

diversion, a program’s objectives may include education of the public, 

physicians, and pharmacists regarding the nature and extent of the 

problem and medical treatment options for abusers of diverted drugs. With 

regard to design, the programs vary primarily in terms of the specific drugs 

they cover and the type of state agency in which they are housed. Some 

PDMPs cover only those prescription drugs that are most prone to abuse 

and addiction, whereas others provide more extensive coverage. In 

addition, most programs are administered by a state law enforcement 

agency, a state department of health, or a state board of pharmacy. Finally, 

some programs use the prescription data proactively, to identify trends or 

patterns of use, as well as to respond to requests from law enforcement 

officials, whereas others use it only to respond to requests. 

States with PDMPs have realized benefits in their efforts to reduce drug 

diversion. These include improving the timeliness of law enforcement and 

regulatory investigations. For example, Kentucky’s state drug control 

investigators took an average of 156 days to complete the investigation of 

an alleged doctor shopper prior to the implementation of the state’s 

PDMP. The average investigation time dropped to 16 days after the 

program was established. In addition, law enforcement officials in 

Kentucky and other states view the programs as a deterrent to doctor 

shopping, because potential diverters are aware that any physician from 

whom they seek a prescription may first examine their prescription drug 

utilization history based on PDMP data. 

Officials from DEA, the Alliance, and state PDMPs told us that states 

considering establishing a PDMP, or expanding an existing one, face 

several challenges. These include educating the public and policymakers 

about the extent of prescription drug diversion and abuse in their state 

and the benefits of a PDMP, responding to the concerns of physicians, 

patients, and pharmacists regarding the confidentiality of prescription 

information, and funding the cost of program development and operations. 

Given a state’s particular funding availability and budget priorities, 

program costs can be a major hurdle. The start-up costs for the three most 

recent PDMPs were $415,000 for Kentucky, $134,000 for Nevada, and 

$50,000 for Utah. Estimated annual operating costs for these PDMPs 

varied from a high of about $500,000 in Kentucky, to $150,000 in Utah and 

$112,000 in Nevada. Costs in these three states vary because of differences 

Results in Brief 
Page 4 GAO-02-634 Prescription Drug Monitoring Programs 

in the PDMP systems implemented, the number of pharmacies reporting 

drug dispensing data, and the number of practitioners and law 

enforcement agencies seeking information from the systems. (See app. I.) 

National efforts to assist states in addressing illegal diversion have focused 

on providing guidance and technical assistance. The Alliance has provided 

a useful source of information for the development of recent state 

programs. In addition to identifying the key features of a model PDMP, the 

Alliance has provided a draft model law for states interested in 

establishing their own PDMP. The Alliance has also provided technical 

assistance to states in implementing the recommendations in the model 

program. Funding has recently been made available for grants to states 

that are planning to start a PDMP or expand an existing program. Two 

million dollars in grants from the Department of Justice’s Bureau of 

Justice Assistance are to be administered jointly with the DEA. 

DEA, the Alliance, and the PDMPs in Kentucky, Nevada, and Utah 

reviewed a draft of this report and in general agreed with its contents. 

Their technical comments have been incorporated where appropriate. 

The diversion and abuse of prescription drugs are associated with 

incalculable costs to society in terms of addiction, overdose, death, and 

related criminal activities. DEA has stated that the diversion and abuse of 

legitimately produced controlled pharmaceuticals constitute a 

multibillion-dollar illicit market nationwide.5

 One recent example of this 

growing diversion problem is the controlled substance oxycodone, the 

active ingredient in over 20 prescription drugs, including OxyContin, 

Percocet, and Percodan. OxyContin has become the nation’s number one 

prescribed narcotic medication for treating chronic severe and moderate 

pain. A single 40-milligram OxyContin tablet legally selling for about $4 is 

worth about $40 on the illicit market. As of February 2002, OxyContin has 

been involved in 464 deaths from prescription drug abuse, as reported by 

DEA on the basis of medical examiners’ autopsy findings for 2000 and 2001 

from 32 states. 

 5

Drug Enforcement Administration and the National Alliance for Model State Drug Laws, A 

Closer Look at State Prescription Monitoring Programs 

(http://www.deadiversion.usdoj.gov/pubs/program/rx-monitor/summary.htm accessed 

September 17, 2001). 

Background 
Page 5 GAO-02-634 Prescription Drug Monitoring Programs 

Combating the illegal diversion of prescription drugs while ensuring that 

the pharmaceuticals remain available for those with legitimate medical 

need involves the efforts of both federal and state government agencies. 

The Controlled Substances Act of 19706

 provides the legal framework for 

the federal government’s oversight of the manufacture and wholesale 

distribution of controlled substances. The states address these issues 

through their regulation of the practice of medicine and pharmacy.7

The Controlled Substances Act of 1970 established a classification 

structure for drugs and chemicals used in the manufacture of drugs that 

are designated as controlled substances. Controlled substances are 

classified into five schedules on the basis of their medicinal value and 

potential for abuse, addiction, and dependence. Schedule I drugs—

including heroin, marijuana, and hallucinogens such as LSD and PCP—

have a high potential for abuse and no currently accepted medical use. 

Schedule II drugs—including methylphenidate (Ritalin) and opiates such 

as hydrocodone, morphine, and oxycodone—have a high potential for 

abuse and may lead to severe physical dependence, but have a currently 

accepted medical use. Drugs on Schedules III through V have medical uses 

and successively lower potentials for abuse and dependence. Schedule III 

drugs include anabolic steroids, codeine, hydrocodone in combination 

with aspirin or acetaminophen, and some barbiturates. Schedule IV 

contains such drugs as the anti-anxiety medications diazepam (Valium) 

and alprazolam (Xanax). Schedule V includes preparations such as cough 

syrups with codeine. All drugs but those in Schedule I are legally available 

to the public with a prescription.8

Under the act, DEA has the authority to regulate transactions involving the 

sale and distribution of controlled substances at the manufacturer and 

wholesale distributor levels. DEA’s Office of Diversion Control (ODC) 

provides legitimate handlers of controlled substances—including 

manufacturers, distributors, hospitals, pharmacies, practitioners, and 

researchers—with registration numbers, which are used in all transactions 

 6

Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970 (Pub. L. No. 

91-513, §§100-103, 84 Stat. 1236, 1242-1284). 

7

According to the Kentucky PDMP administrator, the state has also chosen to regulate drug 

manufacturers and wholesalers. 

8

Some Schedule V drugs that contain limited quantities of certain narcotic and stimulant 

drugs are available over the counter without a prescription. 

Controlled Substances Act 
Page 6 GAO-02-634 Prescription Drug Monitoring Programs 

involving controlled substances. Registrants must comply with a series of 

regulatory requirements relating to drug security and accountability 

through the maintenance of inventories and records. Although all 

registrants, including pharmacies, are required to maintain records of 

controlled substance transactions, only manufacturers and distributors are 

required to report their transactions involving Schedule II drugs and 

Schedule III narcotics, including sales to the retail level, to ODC. The data 

provided to ODC are available for use in investigations of illegal diversions 

at the manufacturer and wholesaler levels. Although data are reported to 

ODC regarding purchases by pharmacies, the act does not require the 

reporting of dispensing information by pharmacies at the patient level to 

ODC. 

State laws govern the prescribing and dispensing of prescription drugs by 

licensed health care professionals. All states require that physicians 

practicing in the state be licensed, and state medical practice laws 

generally outline standards for the practice of medicine and delegate the 

responsibility of regulating physicians to state medical boards. State 

medical boards license physicians and grant them prescribing privileges.9

In addition, state medical boards investigate complaints and impose 

sanctions for violations of the state medical practice laws. 

Every state requires resident pharmacists and pharmacies to be licensed. 

The regulation of the practice of pharmacy is based on state pharmacy 

practice acts and regulations enforced by the state boards of pharmacy. 

The state boards of pharmacy are also responsible for ensuring that 

pharmacists and pharmacies comply with applicable state and federal laws 

and for investigating and disciplining those that fail to comply. All state 

pharmacy laws require that records of prescription drugs dispensed to 

customers be maintained and that state pharmacy boards have access to 

the prescription records. 

 9

The types of practitioners who prescribe drugs and may be monitored by a PDMP vary 

among states. Physicians are the majority of covered practitioners, but in most states many 

nonphysicians also have prescribing authority, including physician assistants, dentists, 

optometrists, podiatrists, veterinarians, and certain types of nurses, such as nurse 

practitioners and advanced practice nurses. 

State Regulation of the 

Practice of Medicine and 

Pharmacy 
Page 7 GAO-02-634 Prescription Drug Monitoring Programs 

PDMPs are designed to facilitate the collection, analysis, and reporting of 

information on the prescribing, dispensing, and use of prescription drugs 

within a state. An overriding goal of PDMPs is to uphold both the state 

laws ensuring access to appropriate pharmaceutical care by citizens and 

the state laws deterring diversion. 

The first PDMP was established in California in 1940. The number of states 

with PDMPs has grown only slightly over the past decade, from 10 in 199210

to 15 in 2002. (See fig. 1.) Nevertheless, PDMPs cover about 47 percent of 

the nation’s population, about 47 percent of the nation’s DEA-registered 

practitioners, and about 45 percent of the nation’s pharmacies.11

The nationwide number of PDMPs has been changing. West Virginia 

terminated its PDMP in 1998, and New Mexico in 2000. West Virginia has 

taken steps to create a new PDMP, however. Legislation to establish a new 

program, again to be operated by the state’s board of pharmacy, was 

enacted and approved by the governor in March 2002. In addition, a 

number of other states have enacted or are considering legislation to 

establish a program. (See fig. 1.) 

 10U.S. General Accounting Office, Prescription Drug Monitoring: States Can Readily 

Identify Illegal Sales and Use of Controlled Substances, GAO/HRD-92-115 (Washington, 

D.C.: July 21, 1992). 

11These percentages include two states that subsequently terminated their PDMPs—New 

Mexico and West Virginia. 

State PDMPs 
Page 8 GAO-02-634 Prescription Drug Monitoring Programs 

Figure 1: Status of Prescription Drug Monitoring Programs, by State, April 2002 

a

Pennsylvania does not have a PDMP, but requires pharmacies to submit data to the state attorney 

general’s office. 

b

West Virginia terminated its PDMP in 1998 and has enacted legislation in 2002 to create a new 

program. 

c

New Mexico terminated its PDMP in 2000. 

Source: National Alliance for State Model Drug Laws, 2002, and discussions with officials in New 

Mexico, Pennsylvania, and West Virginia. 

CA

OR

WA

MT

ID

ND

SD

IA

MO

AR

TN

KY

WY

NV

UT

AZ NMc

OK

TX

HI

CO

KS

NE

MN

WI

IL

MI

IN

OH

PAa

WVb

VA

NC

SC

AL GA

FL

MS

LA

NY

VT

ME

MA

RI

NH

DE

MD

CT

NJ

States that do not have prescription drug monitoring programs

States that have a task force and are considering legislation to establish a program

States that have recently introduced legislation to establish a program

States that have prescription drug monitoring programs

AK
Page 9 GAO-02-634 Prescription Drug Monitoring Programs 

Since 1993, the Alliance has served as a resource center for states 

interested in identifying legislative and program improvements in drug 

abuse reduction and prevention. Each year since fiscal year 1995, the 

Alliance has received a $1 million grant from the Department of Justice, 

administered by the President’s Office of National Drug Control Policy. 

These funds are used to identify legislative, policy, and program initiatives 

to address the supply of, abuse of, and addiction to alcohol and other 

drugs. The model laws cover a broad range of issues, including money 

laundering, forfeiture, housing, education, treatment, prevention, and 

intervention. The funds also support statewide model drug law summits 

that serve as intensive needs assessments and planning vehicles for the 

states. The Alliance has also sponsored a Prescription Monitoring Work 

Group composed of representatives from pharmaceutical manufacturers, 

state licensing boards for physicians and pharmacists, state attorneys 

general, and administrators of state PDMPs. 

The 15 PDMPs have a common goal of reducing prescription drug 

diversion and abuse, but vary in their objectives, design, and operation. In 

addition to helping law enforcement identify and prevent prescription drug 

diversion, state programs may include education objectives to provide 

information to physicians, pharmacies, and the public. Program design 

also varies across states, in terms of which drugs are covered, how 

prescription information is collected, and which agency is given 

responsibility for the program. Additionally, methods for analyzing the 

data to detect potential diversion activity differ among PDMPs. Finally, the 

cost of the program varies according to differences in these design and 

operational factors. 

Although the primary objective of PDMPs is to assist law enforcement in 

detecting and preventing drug diversion, states have also used the 

programs for educational purposes. Programs assist law enforcement 

authorities both by providing information in response to requests for 

assistance on specific investigations and by referring matters to law 

enforcement officials when PDMP evaluations reveal atypical prescribing 

or dispensing patterns that suggest possible illegal diversion. PDMPs have 

also been used to educate physicians, pharmacies, and the public about 

the existence and extent of diversion, diversion scams, and the drugs most 

likely to be diverted by individuals. Programs have provided educational 

materials to physicians on ways to prevent drug diversion and to educate 

their patients about the diversion problem. They have evaluated 

prescribing patterns to identify medical providers that may be 

National Alliance for 

Model State Drug Laws 

PDMPs Vary in 

Objectives, Design, 

and Operation 

Program Objectives 

Include Education as Well 

as Law Enforcement 
Page 10 GAO-02-634 Prescription Drug Monitoring Programs 

overprescribing and inform them that their patterns are unusual. They 

have also identified patients who may be abusing or diverting prescription 

drugs and provided this information to practitioners. For example, PDMPs 

in Nevada and Utah send physicians drug utilization letters containing 

patient information that signal potential diversion activity, including the 

number and types of drugs prescribed to the patient during a given time 

period and the pharmacies that dispensed the drugs. PDMPs have also 

provided physicians with information on addiction treatment options for 

patients identified as drug abusers or diverters. For example, Nevada’s 

PDMP encourages physicians to refer identified doctor shoppers to pain 

management or drug treatment programs that can help them manage their 

chronic pain more effectively or treat their addiction. 

Program design varies across state programs, in terms of which drugs are 

covered, how prescription information is monitored and collected, and 

which agency is given the responsibility for the program. (See table 1.) 

Program Designs Differ 

Across States 
Page 11 GAO-02-634 Prescription Drug Monitoring Programs 

Table 1: Characteristics of State Prescription Drug Monitoring Programs 

State 

Year 

implemented 

Controlled substance 

schedule(s) monitored Type of monitoring system Administrative agency 

Californiaa 1940 II Electronic and triplicate formb Pharmacy and law enforcement 

Hawaii 1943 II Electronic Law enforcement 

Idaho 1967 II, III and IV Electronic Pharmacy board 

Illinois 1961 II Electronic Public health 

Indiana 1995 II Electronic Law enforcement 

Kentucky 1999 II, III, IV and V Electronic Public health 

Massachusetts 1992 II Electronic Public health 

Michiganc 1989 II Single form Commerce 

Nevada 1997 II, III, and IV Electronic 

Pharmacy board and law 

enforcement 

New Yorkd 1977 II Electronic Public health 

Oklahoma 1991 II Electronic Law enforcement 

Rhode Island 1979 II, III Electronic Public health 

Texase 1982 II Electronic Law enforcement 

Utah 1997 II, III, IV, and V Electronic Commerce’s Licensing Division 

Washingtonf 1987 

Determined by disciplinary 

authority Triplicate formb Public health 

a

California is currently testing an electronic monitoring program for Schedule II controlled substances. 

Until the pilot program is completed on July 1, 2003, pharmacies will also have to continue submitting 

copies of the triplicate forms to the state monitoring agency. 

b

A triplicate prescription form is a paper prescription form issued by the state to prescribers, who must 

use it when writing prescriptions for covered controlled substances. The prescriber keeps one copy 

after writing the prescription, and the pharmacist keeps a copy when the prescription is filled and 

sends the third copy to the state PDMP. 

c

In 2001, Michigan enacted legislation to convert its PDMP to an electronic monitoring program. Until 

the new electronic system is implemented, the program will continue to require pharmacies to submit 

copies of state-issued official prescription forms for schedule II controlled substances. 

d

As of January 1, 2002, New York switched to an electronic monitoring system from a paper-based 

system using a triplicate form. The new electronic system is supplemented by a state-issued, singlecopy prescription form that includes a number of security features to prevent counterfeits. 

e

Beginning in September 1999, Texas permitted pharmacies to submit prescription data electronically 

rather than submitting paper copies of prescription forms. In March 2002, Texas switched from 

triplicate to single-copy forms with a number of security features to prevent counterfeits. The 

requirement to submit prescription forms to the state agency will continue until the electronic system 

is fully implemented. 

f

The Washington program applies only to licensed practitioners whose prescribing practices require 

monitoring because of past drug abuse or inappropriate prescribing. The drugs the program covers 

vary, depending on the prescriber, from one controlled substance to all prescriptions. 

Source: National Alliance for Model State Drug Laws. Information is current through February 4, 

2002. 
Page 12 GAO-02-634 Prescription Drug Monitoring Programs 

State programs vary in the controlled substance schedules they cover, in 

part because of differences in available resources and other state-specific 

factors such as levels of drug abuse. As shown in table 1, nine PDMPs 

cover only Schedule II controlled substances, which have the highest 

potential for abuse and addiction. Two states, Kentucky and Utah, cover 

all schedules, and Nevada covers Schedules III and IV, as well as II. 

Washington’s program is used as a disciplinary tool and covers a variety of 

controlled substance schedules on a case-by-case basis for each 

practitioner. Most experts agree that covering all schedules prevents drug 

diverters from avoiding detection by bypassing Schedule II drugs and 

switching to drugs in other schedules. Program officials in Kentucky and 

Utah also told us that covering all schedules allows them flexibility to 

respond if drugs on other schedules become targets for diversion. 

Covering more than Schedule II drugs greatly increases the number of 

prescriptions that must be reported to the state PDMP. This can require 

additional resources to review and interpret the additional data and 

conduct necessary follow-ups. These officials, as well as officials from 

DEA and the Alliance, agree that comprehensive coverage of all schedules 

offers the most effective monitoring program. However, the Alliance’s 

work group recommended that each state determine the schedules its 

program will cover. 

Most PDMPs use electronic monitoring systems, in which pharmacies 

transmit prescription data for covered drugs electronically to the 

designated state agency or a private contractor at least once a month. 

Experts agree that electronic systems make it easier for law enforcement 

to identify drug diverters, reduce investigation time and paperwork, and 

provide easier access to information. Recently, New York and Illinois 

converted from paper-based to electronic programs, and Texas and 

Michigan have recently passed legislation to convert their programs to 

electronic systems. 

Five states—California, Idaho, Michigan,12 New York, and Texas—

supplement their electronic systems with state-issued paper prescription 

forms to help prevent forgeries and counterfeits. These forms can be 

either single or triplicate and are made available by the state to 

prescribers. New York and Texas have recently switched or are in the 

process of switching from triplicate to single forms. The single forms 

include a number of safety features that prevent them from being 

 12Michigan is moving to an electronic system. 
Page 13 GAO-02-634 Prescription Drug Monitoring Programs 

photocopied or scanned, such as watermarks. Kentucky requires 

prescribers to use non-state-issued secure safety forms when dispensing 

controlled substances. 

States have assigned the administrative responsibility for PDMPs to 

various state agencies and regulatory bodies. Most programs are 

administered by a law enforcement agency, a state department of health, 

or a state board of pharmacy. 

States use different approaches to analyzing the prescription information 

they receive. A few states routinely analyze prescription data collected by 

the PDMPs to identify individuals, physicians, or pharmacies that have 

unusual use, prescribing, or dispensing patterns that may suggest potential 

drug diversion, abuse, or doctor shopping. States refer to this as a 

proactive approach to identifying drug diversion. Trend analyses are 

shared with appropriate entities, such as law enforcement, practitioners, 

and regulatory and licensing boards. In contrast, most state PDMPs 

generally use the prescription data to respond to requests for information. 

These requests may come from physicians or from law enforcement or 

state officials based on leads about potential instances of diversion. 

According to state program officials, most PDMPs operate in the latter 

fashion because of the increased amount of resources required to operate 

a proactive system. 

The differences in program costs among all PDMP states reflect a number 

of design and operational factors. In addition to the choice of controlled 

substance schedules monitored, these factors include computer 

programming choices, number and type of staff and contractors, 

turnaround times and report transmittal methods, number and type of 

requests, and number of reporting entities, such as pharmacies. 

If the PDMP is electronically based, there are ongoing computer 

maintenance and programming costs. If a private contractor collects the 

raw data from dispensers and converts them to a standardized format, the 

PDMP pays annual contracting costs for database maintenance. Kentucky 

and Nevada privately contract with the same company to collect data for 

their program database. Utah, in contrast, collects and maintains drugdispensing data in-house, using its own software and hardware. 

The number and type of staff a state chooses to operate its PDMP also 

vary and affect program costs. Kentucky’s PDMP employs four full-time 

A Few PDMPs Operate 

Proactively, but Most 

Operate Reactively 

Design and Operational 

Factors Affect Program 

Costs 
Page 14 GAO-02-634 Prescription Drug Monitoring Programs 

and four part-time staff to help ensure the accuracy of its reports, 

including a pharmacist-investigator who reviews each report before it is 

sent. Nevada’s PDMP operates with one employee because a private 

contractor collects the data. In contrast, Utah’s PDMP, with three full-time 

employees and no private contractor, has one program administrator who 

collects all dispensing data and converts them to a standardized format for 

monitoring, and maintains the database. The two other staff answer 

requests. 

If the PDMP seeks to provide same-day responses to report requests, the 

costs involved in returning the response to the requester may increase. For 

example, Kentucky has spent up to $12,000 in 1 month for faxing reports. 

PDMP officials from Kentucky, Nevada, and Utah estimated 3- to 4-hour 

turnaround times for PDMP data requests, and all mainly use faxing, rather 

than more costly mailing, to return the report to the requester. Same-day 

PDMP responses may be preferable for physicians who want the 

prescription drug history for a patient being seen that day, and for law 

enforcement users who need immediate data for investigations of 

suspected illegal activity. 

As users become more familiar with the benefits of PDMP report data, 

requests and the attendant costs to provide them may increase. In 

Kentucky, Nevada, and Utah, usage has increased substantially, mostly 

because of the increased number of requests by physicians to check 

patients’ prescription drug histories. In Kentucky, these physician requests 

increased from 28,307 in 2000, the first full year of operation, to 56,367 in 

2001, an increase of nearly 100 percent. Law enforcement requests 

increased from 4,567 in 2000 to 5,797 in 2001, an increase of 27 percent. 

Similarly, Nevada’s requests from all authorized users have also 

increased—from 480 in 1997, its first full year, to 6,896 in 2001, an increase 

of about 1,400 percent. 

Additionally, as a PDMP matures, the needs it addresses may change, and 

operating costs may increase as a result. If users want PDMP reports to 

reflect more timely information, dispensing entities would have to report 

their data at the time of sale, rather than submitting data biweekly or 

monthly, to capture the most recent prescription dispensing. If users want 

to be alerted if a certain drug, practitioner, or pharmacy may be involved 

in a developing diversion problem, PDMPs would have to initiate periodic 

data analysis to determine trends or patterns. Such PDMP enhancements 

would entail additional costs, including costs for computer programming, 

and data analysis. Kentucky’s PDMP is currently seeking $1.4 million in 

additional operating funds to meet costs related to increased PDMP usage 
Page 15 GAO-02-634 Prescription Drug Monitoring Programs 

by all users, particularly physicians, and to be able to provide periodic 

reports about state drug usage trends and possible diversion. 

States with PDMPs have experienced considerable reductions in the time 

and effort required by law enforcement and regulatory investigators to 

explore leads and the merits of possible drug diversion cases. The 

presence of a PDMP helps a state reduce its illegal drug diversion, but 

diversion activities may increase in contiguous states without PDMPs. 

The ability of PDMPs to focus law enforcement and regulatory 

investigators on suspected drug diversion cases to specific physicians, 

pharmacies, and patients who may be involved in the alleged activities is 

crucial to shortened investigation time and improvements in productivity. 

States that do not have PDMPs must rely on tips from patients, 

practitioners, or law enforcement authorities to identify possible 

prescription drug abuse and diversion. Following up on these leads 

requires a lengthy, labor-intensive investigation. In contrast, PDMPs 

provide information that allows investigators to pinpoint the physicians’

offices and pharmacies where drug records must be reviewed to verify 

suspected diversion and thus eliminates the need to search records at 

physicians’ offices and pharmacies that have no connection to a case. 

Prior to implementation of Kentucky’s PDMP, its state drug control 

investigators took an average of 156 days to complete the investigation of 

alleged doctor shoppers. Following the implementation, the average 

investigation time dropped to 16 days. Similarly, Nevada reduced its 

investigation time from about 120 days to about 20 days, and a Utah 

official told us that they experienced an 80 percent reduction in 

investigation time. 

Officials from Kentucky, Nevada, and Utah told us that PDMPs have 

helped reduce the unwarranted prescribing and subsequent diversion of 

abused drugs in their states. In both Kentucky and Nevada, an increasing 

number of PDMP reports are being used by physicians to check the 

prescription drug utilization history of current and prospective patients to 

determine whether it is necessary to prescribe certain drugs that are 

subject to abuse. Law enforcement officials told us that they view these 

drug history checks as initial deterrents—a front-line defense—to prevent 

State Programs Have 

Helped Shorten 

Investigation Time 

and Reduced Illegal 

Drug Diversion 

Investigation Time and 

Productivity Have 

Improved 

Programs Have Helped 

Reduce Availability of 

Abused Drugs 
Page 16 GAO-02-634 Prescription Drug Monitoring Programs 

individuals from visiting multiple physicians to obtain prescriptions, 

because patients are aware that physicians can review their prescription 

drug history. For an individual who may be seeking multiple controlled 

substance prescriptions, the check allows a physician to analyze the 

prescription drug history to determine whether drug treatment appears 

questionable, and if so, to verify it with the listed physicians. In Kentucky, 

a physician can request a PDMP report the same day as a patient’s 

appointment, and usually receives the patient’s drug history report within 

4 hours of making the request. Kentucky’s PDMP typically receives about 

400 physician requests daily, and can provide data current to the most 

recent 2 to 4 weeks. 

The presence of a PDMP may also have an impact on the use of drugs 

more likely to be diverted. For example, DEA rank-ordered all states for 

2000 by the number of OxyContin prescriptions per 100,000 people.13 Eight 

of the 10 states with the highest number of prescriptions—West Virginia, 

Alaska, Delaware, New Hampshire, Florida, Pennsylvania, Maine, and 

Connecticut—had no PDMPs, and only 2 did—Kentucky and Rhode Island. 

Six of the 10 states with the lowest number of prescriptions—Michigan, 

New Mexico,14 Texas, New York, Illinois, and California—had PDMPs, and 

4—Kansas, Minnesota, Iowa, and South Dakota—did not. 

The existence of a PDMP within a state, however, appears to increase drug 

diversion activities in contiguous non-PDMP states. When states begin to 

monitor drugs, drug diversion activities tend to spill across boundaries to 

non-PDMP states. One example is provided by Kentucky, which shares a 

boundary with seven states, only two of which have PDMPs—Indiana and 

Illinois. As drug diverters became aware of the Kentucky PDMP’s ability to 

trace their drug histories, they tended to move their diversion activities to 

nearby nonmonitored states. OxyContin diversion problems have 

worsened in Tennessee, West Virginia, and Virginia—all contiguous non-

 13OxyContin, Hearings Before the Subcommittee on the Departments of Commerce, 

Justice, and State, the Judiciary, and Related Agencies, House Committee on 

Appropriations, 107th Cong. Part 10, pp. 21, 22 (2001) (Statement of Asa Hutchinson, 

Administrator of the Drug Enforcement Administration). 

14New Mexico’s PDMP was terminated in June 2000. 
Page 17 GAO-02-634 Prescription Drug Monitoring Programs 

PDMP states—because of the presence of Kentucky’s PDMP, according to 

a joint federal, state, and local drug diversion report.15

States that are considering establishing or expanding a PDMP face a 

variety of challenges. One challenge is the lack of awareness of the extent 

to which prescription drug abuse and diversion is a significant public 

health and law enforcement problem. States also face concerns about the 

confidentiality of the information gathered by the PDMP, voiced by 

patients who are legitimately using prescription drugs and by physicians 

and pharmacists who are legitimately prescribing and dispensing them. 

Another challenge states face is securing adequate funding to initiate and 

develop the program and to maintain and modify it over time. 

One challenge faced by states attempting to control diversion and abuse of 

controlled substances is a lack of awareness of the seriousness of this 

public health and law enforcement problem. Nationally, prescription drug 

abuse involves a multibillion-dollar illegal diversion market, results in 

deaths of abusers, and is as significant a problem as abuse of illegal drugs. 

In Kentucky, the state police alerted state officials, including the attorney 

general and the governor, about the extent of the state’s prescription drug 

abuse problem. A task force was established with state legislators and 

representatives from law enforcement, public health, and education, 

which recommended that the state establish a PDMP. About 3 years later, 

the abuse and diversion of OxyContin in eastern Kentucky became a major 

concern, prompting the governor to create an OxyContin task force. The 

task force recommended enhancing the PDMP’s capability to identify 

doctor shoppers by increasing the timeliness of data collection, analysis, 

and dissemination through development of an online, real-time data entry 

system for pharmacists. Another recommendation was to develop an 

educational program so PDMP users, such as physicians, pharmacists, and 

law enforcement officials, could better understand the system’s enhanced 

capabilities. 

 15Appalachia High Intensity Drug Trafficking Area Investigative Support Center, with the 

assistance of the National Drug Intelligence Center, The OxyContin Threat in Appalachia, 

August 2001. 

Challenges Exist in 

Establishing and 

Expanding State 

PDMPs 

Extent of Diversion and 

Abuse Is Not Always 

Recognized 
Page 18 GAO-02-634 Prescription Drug Monitoring Programs 

Both physicians who legitimately prescribe prescription drugs and 

patients who legitimately use them are concerned that the information 

collected, centrally maintained, and monitored by state PDMPs may be 

used inappropriately or compromised. All states, regardless of whether 

there is a state PDMP, have the authority under their laws to conduct 

investigations of the records of individuals alleged to be involved in 

prescription drug diversion and abuse, including the records of prescribing 

physicians and dispensing pharmacies. PDMPs, particularly those with 

electronic databases, raise additional confidentiality concerns, however, 

because their databases contain complete dispensing records that can 

more quickly identify individual patients, physicians, and pharmacies and 

provide an individual report on their prescription drug history. Physicians 

are concerned that their prescribing decisions and patterns may be 

questioned and that they could be investigated without sufficient cause. 

Some physicians contend that patients may suffer because physicians will 

be reluctant to prescribe appropriate controlled substances to manage a 

patient’s pain or treat their condition. Patients are concerned that their 

personal information may be used inappropriately by those with 

authorized access or shared with unauthorized entities. Pharmacists have 

also expressed concerns. In New Mexico, the Board of Pharmacy repealed 

the administrative regulations necessary to operate the state’s electronic 

PDMP following confidentiality concerns raised by some pharmacists who 

were apprehensive they might be targeted for investigation based on the 

volume of controlled substance drugs they dispensed. 

Some states have attempted to address these concerns statutorily. For 

example, some state laws to regulate controlled substances and to operate 

a PDMP include health privacy protection provisions.16 In addition, states 

with PDMPs generally have statutory and regulatory protections to limit 

access and use of confidential health care data, as well as statutory 

penalties for misuse. Under Kentucky’s electronic PDMP, for example, the 

authorized users of its information are statutorily delineated, the knowing 

misuse of the data can result in a felony conviction, and the PDMP itself is 

statutorily accountable for ensuring that only authorized users receive its 

 16The federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) 

generally preempts state health information privacy laws, unless they provide a higher level 

of protection than the act. (Pub. L. No.104-191, §262, 110 Stat. 1936, 2029.) However, these 

state privacy provisions may not be preempted if the Secretary of Health and Human 

Services determines that the state law has as its principal purpose the regulation of the 

manufacture, registration, distribution, dispensing, or other control of any controlled 

substances (as defined in 21 U.S.C. §802), or that is deemed a controlled substance by state 

law. (45 C.F.R. §160.203 (a)(2)) 

Physicians, Patients, and 

Pharmacists Express 

Concerns About 

Confidentiality 
Page 19 GAO-02-634 Prescription Drug Monitoring Programs 

data. Kentucky law also prohibits any person who receives PDMP data 

from sharing that information with anyone else, unless required by a court, 

and the Kentucky PDMP advises data recipients of this prohibition. 

Nevada’s state law similarly protects the confidentiality of its PDMP 

information by requiring a court order for disclosure to nonauthorized 

entities. Also, Nevada’s Board of Pharmacy has legal authority to discipline 

and fine an individual for violating the confidentiality law. For example, 

the board brought legal action against a pharmacist who provided an 

employer with prescription utilization information on a worker whom the 

employer subsequently fired. The pharmacist was fined $2,000 and was 

given probationary discipline. 

According to officials from the National Alliance for Model State Drug 

Laws, the National Association of Drug Diversion Investigators, and the 

DEA, securing program funding is a critical challenge faced by states that 

choose to develop, maintain, or expand a PDMP. They add that funding 

availability is crucial to states’ ability to establish and continue PDMPs. 

Given a state’s particular funding availability and priorities, PDMP costs 

can involve a major hurdle. According to state officials, the start-up costs 

for the three most recent PDMPs were $415,000 for Kentucky in 1999, 

$134,000 for Nevada in 1996,17 and $50,000 for Utah in 1996. Estimated 

annual operating costs for these PDMPs varied from a high of about 

$500,000 in Kentucky to $112,000 in Nevada and $93,000 in Utah. These 

three PDMPs are supported by state funds and do not charge fees for 

providing data reports to their users. In contrast, the West Virginia PDMP 

was terminated in 1998 primarily because of a lack of state funding 

support, according to an official of the state board of pharmacy, which 

operated the program. The board had been required to fund the PDMP 

through the revenue generated by its licensing and related fees, without 

additional state funds, but was unable to sustain operation of both its 

licensing and regulatory program and its PDMP through these revenues 

alone. 

 17Nevada received a total of $265,000 for the first 2 years of the program’s operations, 

including 2-year grants from two pharmaceutical companies and the state board of medical 

examiners. 

Securing Program Funding 

Is a Critical Challenge 
Page 20 GAO-02-634 Prescription Drug Monitoring Programs 

Efforts at the national level to assist states in addressing illegal diversion 

have focused on providing guidance and technical assistance. The 

National Alliance for Model State Drug Laws has identified the key 

features of a model PDMP and drafted a model law that states could adopt. 

Both the Alliance and DEA have provided information to states about the 

nature of drug diversion problems and guidance on how to deal with them. 

DEA has also assisted states in initiating new PDMPs and improving 

existing ones. 

The Alliance published the final report from its Prescription Monitoring 

Work Group in February 2002. The report identified the key features of a 

model PDMP. It recommended that PDMPs cover all schedules of 

controlled substances, use some form of an electronic monitoring system, 

safeguard the confidentiality of the prescription data collected, analyze the 

data to provide information for law enforcement and medical 

professionals, provide education to health professionals regarding the 

monitoring system and pain management, and include an evaluation 

component to assess its costs and benefits. Along with its work group 

report, the Alliance provided a draft model state law. 

The Alliance also facilitates communication between states that are 

considering a PDMP and states that have programs in place, and provides 

technical assistance to states on implementing its recommendations. It 

reviews draft bills and provides information on current PDMP status, 

trends, and legal matters to state legislatures. For example, the Alliance 

work group recently stressed the need for states to assess the impact of 

the HIPAA privacy provisions on state PDMPs. 

Since the 1980s, DEA has been supportive of state PDMP efforts to detect 

and prevent illegal diversion of prescription drugs at the retail level. DEA’s 

aid has been largely in the form of providing technical assistance to states 

that are seeking to reduce diversion and abuse, and only recently in the 

form of making start-up funding available to states. 

Historically, DEA has routinely supplied educational materials to 

practitioners, dispensers, and the general public on drug diversion. It has 

also provided states with computerized information and intelligence on 

the distribution of certain controlled substances and coordinated major 

investigations. In addition, DEA has served as a program resource for 

states seeking assistance with developing PDMPs and drafting and 

promulgating regulations. 

National Efforts Have 

Focused on Providing 

Guidance and 

Technical Assistance 

The Alliance Provides 

Models and Technical 

Assistance for States 

DEA Has Assisted States in 

Dealing with Drug 

Diversion and Abuse 
Page 21 GAO-02-634 Prescription Drug Monitoring Programs 

Over the past 11 years, three states have obtained federal funds to initiate 

PDMPs: Kentucky (1998), Massachusetts (1992), and Oklahoma (1991). 

More recently, additional funding has been made available for grants to 

states that are planning to start a PDMP or expand an existing program. 

Two million dollars in grants from the Department of Justice’s Bureau of 

Justice Assistance is to be administered jointly with the DEA.18 DEA and 

the Bureau of Justice Assistance designed the grant program to allow 

states with legislation or regulations for a PDMP program in place or 

pending to apply for funding. There are also grants available for states 

with existing PDMPs to improve program capabilities through enhanced 

technology. According to DEA, seven New Program Grants of $180,000 

and two Enhanced Program Grants of $220,000 will be available. Several 

states have expressed an interest in applying for the grants because of 

their increased awareness of drug diversion. 

Illegal diversion and abuse of prescription drugs and the associated 

criminal activity are growing problems in many states. Prescription drug 

monitoring programs offer states a more efficient means of detecting and 

deterring illegal diversion. These programs provide state health care 

licensing and regulatory agencies and law enforcement with quick access 

to comprehensive information on the prescribing, dispensing, and 

purchasing of controlled substances that are most likely to be targets for 

diversion. 

Although state PDMPs have aided investigators and helped to reduce 

doctor shopping, the number of states with PDMPs has grown only slightly 

over the past decade, from 10 in 1992 to 15 in 2002. A lack of awareness of 

the magnitude of the problem, concerns about confidentiality on the part 

of patients, physicians, pharmacists, and legislators, and difficulty in 

accessing funding have kept the numbers of PDMPs low. 

Cooperative efforts at the state and national levels are seeking to 

overcome these challenges and increase the number of states with 

programs. For states considering establishing PDMPs, the report by the 

Alliance’s Prescription Monitoring Work Group provides a useful roadmap 

of the critical factors each state needs to consider in order to create an 

 18Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies 

Appropriations Act, 2002, Pub. L. No. 107-77 (2001). The $2 million grant is itemized as the 

“Harold Rogers Prescription Drug Monitoring Program” (H.R. Conf. Rep. No. 107-278, at 

90(2001)). 

Concluding 

Observations 
Page 22 GAO-02-634 Prescription Drug Monitoring Programs 

effective program. Moreover, the $2 million in grants available from the 

Bureau of Justice Assistance, and to be administered jointly with DEA, 

provides states with a potential source of funding to start a PDMP. 

We obtained comments on a draft of this report from DEA, the Alliance, 

and state PDMP officials in Kentucky, Nevada, and Utah. In general, they 

agreed with the report and thought it provided useful information on state 

drug monitoring programs. They also provided technical comments, which 

we incorporated where appropriate. 

As agreed with your office, unless you publicly announce the contents of 

this report earlier, we plan no further distribution until 30 days from the 

report date. At that time, we will send copies of this report to the Attorney 

General of the United States, the Administrator of the Drug Enforcement 

Agency, and others who are interested. We also will make copies available 

to others upon request. In addition, the report will be available at no 

charge on the GAO Web site at http://www.gao.gov. 

If you or your staffs have any questions about this report or would like 

additional information, please call me at (202) 512-7118. Another contact 

and key contributors to this report are listed in appendix II. 

Janet Heinrich 

Director, Health Care—Public Health Issues 

Agency Comments 
Appendix I: Key Features of Selected State 

Prescription Drug Monitoring Programs 

Page 23 GAO-02-634 Prescription Drug Monitoring Programs 

This table summarizes the key features of the state prescription drug 

monitoring programs (PDMPs) in Kentucky, Nevada, and Utah. 

Table 2: Key Features of Selected State Prescription Drug Monitoring Programs 

Key features Kentucky Nevada Utah 

Census 2000 population 4.04 million 1.99 million 2.23 million 

Year operational 1999 1997 1997 

Start-up funding 

$415,000 in federal start-up 

grant funds $134,000a in state funds 

$50,000 in one time state 

funds 

Controlled substance schedules 

monitored II, III, IV, V II, III, IV II, III, IV, V 

Electronic data collection and 

reporting Yes Yes Yes 

Private contractor receives 

dispensing information and creates 

database Yes Yes No 

Annual operating costs (estimate) $500,000 $112,000 $150,000 

Staff 

4 full-time (1 licensed 

pharmacist investigator, 2 

pharmacy technicians, 1 data 

entry operator) and 4 part-time 

1 full-time with all 

administrative duties 

3 full-time including 

manager and 2 support staff 

Number of pharmacies reporting 

dispensing data (estimate) 1,300 387 375 

Number of daily data requests 

received (estimate) 400 20 130 to 150 

Report turnaround time to 

requestor (estimate) 4 hours 4 hours 3 hours 

Penalty for unauthorized use or 

disclosure of PDMP data Class D felonyb

 PDMP statute has no penalty Third-degree felonyc

a

Nevada received $265,000 for the first 2 years of its program’s operations, including 2-year grants 

from two pharmaceutical companies and the state board of medical examiners. 

b

Kentucky law defines a class D felony as one carrying a sentence of at least 1 year, but not more 

than 5 years in prison. 

c

Utah law defines a third-degree felony as one carrying a sentence of not more than 5 years in prison. 

Source: GAO interviews with PDMP administrators. 

Appendix I: Key Features of Selected State 

Prescription Drug Monitoring Programs 
Appendix II: GAO Contact and Staff 

Acknowledgments 

Page 24 GAO-02-634 Prescription Drug Monitoring Programs 

John C. Hansen, (202) 512-7105 

In addition to the above, Robert Dee, Preety Gadhoke, Opal Winebrenner, 

Roseanne Price, and George Bogart made key contributions to this report. 

Appendix II: GAO Contact and Staff 

Acknowledgments 

GAO Contact 

Acknowledgments 

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