Behavioral Health Is Essential To Health • Prevention Works • Treatment Is Effective • People Recover

In Brief

Prescription Drug Monitoring Programs: 

A Guide for Healthcare Providers 

Winter 2017 • Volume 10 • Issue 1 

Since the 1990s, a dramatic increase in prescriptions 

for controlled medications—particularly for opioid pain 

relievers such as oxycodone and hydrocodone—has 

been paralleled by an increase in their misuse1

 and by 

an escalation of overdose deaths related to opioid pain 

relievers.2 The number of state-run prescription drug 

monitoring programs (PDMPs) has also increased during 

this timeframe. Currently, 49 states, the District of 

Columbia, and 1 U.S. territory (Guam) have 

operational PDMPs. 

The first state PDMPs provided law enforcement and other 

public agencies with surveillance data to identify providers 

inappropriately prescribing controlled medications. The 

objective was to minimize harmful and illegal use and 

diversion of prescription medications, without interfering 

with their appropriate medical use. Advances in technology 

have enabled PDMPs to take on another important role— 

that of an adjunct source of information that prescribers 

and pharmacists can use to improve the care and safety of 

individual patients. Helping healthcare providers make the 

most informed prescribing and dispensing decisions, as 

part of an initiative to address opioid-related overdoses and 

deaths, is a federal government priority.3 

This In Brief is targeted to healthcare providers who 

prescribe and/or dispense controlled medications, including 

substance use treatment providers, primary care providers, 

nurse practitioners, physician assistants, pain specialists, 

psychiatrists, and pharmacists. The document explains the 

emergence and purpose of PDMPs and describes how PDMP 

use can enhance clinical decision making and improve 

individual patient safety while also helping curb the public 

health crises of prescription drug misuse and unintentional 

overdose deaths. Additional sources of information are found 

in the Resources section at the end of this document. 

The Evolution of PDMPs 

PDMPs are state-operated databases that collect 

information on dispensed medications. The first PDMP 

was established in 1939 in California, and by 1990 another 

eight state programs had been established.4

 PDMPs would 

periodically send reports to law enforcement, regulatory, 

or licensing agencies as part of efforts to control diversion 

of medication by prescribers, pharmacies, and organized 

criminals. Such diversion can occur through medication or 

prescription theft or illicit selling, prescription forgery or 

counterfeiting, nonmedical prescribing, and other means, 

including diversion schemes associated with sleep clinics 

(sedative-hypnotics and barbiturates), weight clinics 

(stimulants), and pain clinics (opioid medications).4 

The first PDMPs, which were paper based, did not provide 

reports to healthcare providers for use during individual 

patient care; however, today’s electronic databases have 

a variety of features that make them practical for such 

care. Depending on the particular state law, the types of 

professionals who may register to access PDMP records 

include prescribers (e.g., primary care doctors, nurse 

practitioners, physician assistants), dispensers (e.g., 

pharmacists), medical examiners, practitioner licensure 

board members, third-party payers, public health and 

safety agency representatives, and law enforcement and 

drug court personnel.5 The majority of PDMPs permit 

providers to delegate access to a mid-level practitioner, 

such as a registered nurse or a pharmacy technician.5

 In 

more than half of states, prescribers and pharmacists are 

required to register with their respective PDMP; in some 

of these states, registrants are also required to access 

the PDMP for a patient’s prescription history before 

prescribing or dispensing controlled substances.5 
Behavioral Health Is Essential To Health • Prevention Works • Treatment Is Effective • People Recover

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In Brief

The Nation’s Prescription Drug Problem 

Misuse 

■ A 2015 survey indicated that an estimated 3.8 million

people had used prescription pain relievers in the past

month for nonmedical purposes.6 

■ In 2010, there were 33,701 reported admissions

to substance use treatment facilities for combined

benzodiazepine and opioid pain reliever use, an

increase of 569.7 percent from the 5,032 admissions in

the year 2000.7 

■ The number of people who reported receiving treatment

for the nonmedical use of prescription pain relievers

has more than doubled since 2002, reaching 822,000 in

2015.8 

Emergency Department Visits 

■ From 2004 to 2011, the rate of emergency department

visits involving misuse of all classes of pharmaceuticals

increased 114 percent. More than 1.4 million such visits

were made in 2011.9 

■ Over the same 2004–2011 period, the rate of

emergency department visits involving opioid pain

relievers increased 153 percent and involved more than

420,000 visits.9 

Deaths 

■ From 1999 to 2014, the rate of drug poisoning deaths

involving opioid analgesics (powerful prescription

pain relievers) more than quadrupled, with 18,893 such

deaths in 2014.10 

■ Since 2000, the United States has experienced a

200 percent increase in the rate of overdose deaths

involving opioids (opioid pain relievers and heroin).11 

■ In 2014, drug overdose involving some type of opioid

took the lives of 28,647 people; prescription opioids

were involved in at least half of these deaths.11,12 

■ Methadone prescribed for pain puts users at particularly

high risk for overdose death. Methadone is involved

in about one-third of deaths related to opioid pain

relievers, even though only 2 percent of pain reliever

prescriptions are for this medication.13 (Methadone

used in medication-assisted treatment is not considered

part of the escalating problem of prescription drug

misuse; nationwide, only a small percentage of opioidrelated deaths involve patients receiving treatment in

opioid treatment programs [OTPs]).14 

Overview of Current PDMPs 

PDMP databases in most states are housed within a 

licensing or public health agency; in a few states, they are 

located within a law enforcement agency. Most states track 

prescriptions for Schedule II–V controlled medications, 

and some also track unscheduled medications with misuse 

potential (e.g., ephedrine, which can be used in the 

manufacture of methamphetamine). PDMP funding varies 

by state but includes federal, state, or private sources 

and revenue generated through licensing fees or other 

mechanisms.4 

Most PDMPs update their data on a daily or weekly basis, 

enabling prescribers and dispensers to assess a patient’s 

recent patterns of use or misuse. Systems are evolving 

toward even more frequent updating; in 2012, Oklahoma 

became the first state to institute real-time reporting, 

with prescription data available within 5 minutes after 

medication is dispensed.15 Real-time reporting can offer 

some advantages; in particular, emergency department 

care providers can find near real-time prescription histories 

for patients presenting for acute care. 

Some state PDMPs provide batch reporting; this is a utility 

that enables prescribers to obtain summary histories for a 

group of patients, such as those scheduled for upcoming 

appointments. The practitioner can review the summaries 

to determine whether a full report should be ordered for 

any particular patient.4 

A majority of state PDMPs are authorized to send 

unsolicited reports to providers, licensing boards, or law 

enforcement agencies when a prescriber’s or prescription 

recipient’s activity exceeds thresholds established by 

the PDMP.5,16 Unsolicited reports can alert healthcare 

providers to intervene with patients whose prescriptionrelated behavior may suggest substance misuse, whereas 

unsolicited reports to investigative agencies or licensure 

boards can support investigations into potential drug 

diversion or problematic prescribing.16 

More than half of the states5 are building out systems to 

allow for data sharing across systems, agencies, and states. 

Benefits of this system integration include the following: 

providers can obtain patient prescription history within 

the electronic health record system instead of logging 

into two separate systems; state Medicaid agencies can 
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Prescription Drug Monitoring Programs: A Guide for Healthcare Providers

Winter 2017, Volume 10, Issue 1

share information with federal health service providers 

(e.g., U.S. Department of Veterans Affairs, Indian Health 

Service); and adjacent states are able to share information 

to address illicit cross-border prescription filling or to 

provide for better coordination of the care that a patient is 

receiving in different states. 

How PDMP Data Are Collected 

Pharmacies must submit required data to their state’s 

PDMP for each prescription they dispense for specified 

controlled substances. Pharmacies in the U.S. Department 

of Veterans Affairs and in the Indian Health Service 

are also authorized to submit data to PDMPs, and such 

pharmacies in many states do so.17,18 Depending on a 

state’s legislative requirements, the following entities/ 

individuals may also be required to submit prescription 

data when dispensing controlled substances: emergency 

departments, wholesale distributors, licensed hospital 

pharmacies, physicians, veterinarians, dentists, and 

medical and behavioral health service providers. 

Information collected typically includes date dispensed, 

patient, prescriber, pharmacy, medication, and quantity. 

This information is submitted to databases in electronic 

form. The intervals at which pharmacies are required to 

submit data vary by state. 

Privacy and Security 

Ensuring the privacy and security of health information 

is critical for several reasons, including prevention 

of identity theft and medical fraud. One example of 

a safeguard is that many PDMPs are prohibited from 

providing identifying information about individual 

patients or practitioners in reports to law enforcement 

agencies, except in specified situations such as in response 

to a subpoena or for an active case investigation.4,19 Such 

prohibitions are also intended to protect confidentiality 

and avoid potential targeting of providers engaged in 

legitimate prescribing and dispensing activities. 

How Prescribers and Pharmacists Use 

PDMP Data 

PDMP reports can be used by a healthcare practitioner 

with other support tools (e.g., documentation templates, 

patient data reports and summaries, computerized 

alerts and reminders) when screening a new patient or 

monitoring a current patient. The practitioner can review 

the patient’s prescription record from the PDMP to confirm 

or augment information provided by the patient’s own 

reports and the medical exam. Providers can promote 

patients’ acceptance of this tool by proactively informing 

them that PDMP data are routinely checked for all patients 

to enhance care and that confidentiality and privacy are 

protected by law and regulation. 

For example, when treating for chronic pain, a practitioner 

can check the state PDMP for data on the patient’s history 

of prescriptions for controlled substances. This information 

can be used to determine whether the patient is already 

receiving opioid medications or other medications that, 

when combined with an opioid prescription, might put him 

or her at risk for overdose. The Centers for Disease Control 

and Prevention (CDC) advises: “Clinicians should review 

PDMP data when starting opioid therapy for chronic pain 

and periodically during opioid therapy for chronic pain, 

ranging from every prescription to every 3 months.”20 

Whether updated in real time or at some other regular 

interval, a PDMP provides longitudinal information from 

which a healthcare practitioner can identify patterns of 

inappropriate prescription medication use or risky substance 

use behavior. PDMP data may suggest that a patient has an 

uneventful prescription history, giving confidence to the 

practitioner that the patient has a legitimate need for any 

scheduled prescription medications under consideration. The 

data can also reveal whether the patient has been prescribed 

medication that may create a risk for interaction with 

medication the practitioner is considering prescribing. For 

example, the data can suggest the total level of morphine 

equivalent to which a patient already has access and whether 

the patient has access to other medication(s) that may, in 

combination, put the patient at risk for overdose. Another 

potential use of the data is to determine whether a patient 

has failed to fill a prescription for medication previously 

prescribed by that practitioner; in such situations, the 

practitioner can initiate a conversation about why the patient 

is not taking the medication as indicated. 

A practitioner can also use PDMP data to monitor patients 

with suspected or known substance use disorders by 

checking patient records for medically unwarranted 

concurrent use of prescription medication (e.g., high doses 
Behavioral Health Is Essential To Health • Prevention Works • Treatment Is Effective • People Recover

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In Brief

Exceptions to PDMP Data Reporting 

Requirements 

Typically, prescriptions for intravenous medications and 

those filled by hospice palliative care are not submitted 

to PDMPs. In addition, federal confidentiality rules 

(42 CFR Part 2, Confidentiality of Alcohol and Drug 

Abuse Patient Records) exempt medications dispensed at 

OTPs—that is, when a medication for the treatment of a 

substance use disorder (e.g., methadone, buprenorphine) 

is dispensed at an OTP, patient-identifying information is 

not submitted to the PDMP. There are some exceptions 

specified in the federal regulations. OTP-based prescribers 

may access PDMP information to help manage the care 

of their patients, and the Substance Abuse and Mental 

Health Services Administration (SAMHSA) encourages 

them to do so.21 It is especially important that OTP-based 

physicians and physicians who are qualified to prescribe 

buprenorphine for opioid use disorder (i.e., physicians who 

have received a waiver under the Drug Addiction Treatment 

Act of 2000) access the PDMP, because these physicians 

are the only practitioners who have full knowledge of their 

patients’ controlled medication histories. 

of several prescriptions, including long- and short-acting 

opioids as well as benzodiazepines) and use of multiple 

prescribers or pharmacies. Other indicators of potentially 

problematic prescription use that a practitioner can look 

for when reviewing PDMP data include early refills and 

dose escalation. 

Behavior that suggests substance misuse, a substance use 

disorder, or diversion is known as aberrant drug-related 

behavior.* PDMP data can alert a practitioner to aberrant 

behavior such as doctor shopping (obtaining overlapping 

prescriptions from different doctors for intended 

nonmedical use) or pharmacy shopping (visiting multiple 

pharmacies to fill prescriptions); these are called “multiple 

provider episodes.” 

PDMP data are best used in conjunction with other sources 

of information, including clinical assessment, before 

making any determinations about aberrant behavior,22 

because no validated and standardized criteria for the 

threshold of questionable activity have been established.4 

A patient who has obtained prescriptions from multiple 

providers is not necessarily a “doctor shopper”; the 

patient could have legitimately received prescriptions 

from different specialists for diverse conditions (e.g., a 

terminal disease or disorder, chronic pain, postsurgical 

pain). There are also plausible reasons why a patient 

might fill prescriptions at multiple pharmacies (e.g., 

because different pharmacies may be closer to work or 

home, because a particular pharmacy offered a coupon). 

For these reasons, a proposed operational definition 

of shopping behavior for medications at high risk for 

misuse or diversion is having “overlapping prescriptions 

written by different prescribers and filled at three or more 

pharmacies” (emphasis added).23 

When PDMP data, combined with other information, 

indicate that a patient may be engaging in aberrant 

behavior, the practitioner can use this information in the 

medical setting with the patient as a basis for an immediate 

conversation or intervention. To ensure that the patient 

does not misuse prescribed medication, the practitioner can 

monitor PDMP data in conjunction with urine drug testing 

and use of a treatment agreement (a contract between 

patient and practitioner on what each of them will do). 

Before prescribing an opioid for pain, the practitioner can 

assess PDMP data to ensure that a patient is not obtaining, 

through other prescribers, medication with sedative 

effects (e.g., other opioids, benzodiazepines), which could 

heighten risk of overdose when used simultaneously with 

the opioid. PDMPs provide another valuable function 

in that providers can use them to periodically review 

their own prescribing record, to confirm that their Drug 

Enforcement Administration (DEA)-controlled substance 

number has not been used illegally by another person.4,24 

Not only prescribers but also pharmacists are enhancing 

patient care through their use of PDMPs. For example, 

pharmacists can identify interaction risks from multiple 

prescriptions. Pharmacists can also initiate conversations 

with patients whose prescription use patterns indicate 

possible substance misuse, and they can refer such 

patients for screening and counseling and link them with 

informational resources on substance use disorders and 

*Treatment Improvement Protocol (TIP) 54, Managing Chronic Pain in Adults With or in Recovery From Substance Use Disorders, provides a

description of aberrant drug-related behaviors on pages 54 and 56.
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Prescription Drug Monitoring Programs: A Guide for Healthcare Providers

Winter 2017, Volume 10, Issue 1

substance use disorder treatment. Alternatively, they 

can contact the patient’s prescriber, who may be best 

positioned to provide resources or referrals. Pharmacists 

can also use PDMP data to flag suspicious prescribing 

patterns that may indicate aberrant, illicit, or unsafe 

prescribing by medical professionals. 

PDMP Effectiveness 

Provider surveys, case studies, state evaluations, and 

other reports offer growing evidence that individual state 

databases are reducing diversion while also improving 

individual clinical decision making and prescribing 

practices and lowering rates of admissions for substance 

use treatment.25 For example, after New York and Tennessee 

required prescribers to consult their state’s database before 

prescribing pain medications, the percentage of patients with 

multiple provider episodes (receiving prescriptions from five 

or more prescribers or filling prescriptions at five or more 

pharmacies in a 3-month period) dropped 75 percent and 

36 percent, respectively.26 

Evidence from states with mandates also suggests that 

PDMP utilization supports appropriate prescribing and 

dispensing. In the 1-year period beginning 2 months after 

Kentucky’s mandate on enrollment and use of its PDMP 

went into effect (in July 2012), overall dispensing of 

controlled substances in the state declined 8.5 percent. 

In approximately the same period, prescriptions for 

buprenorphine (a medication used in treatment of opioid 

use disorder) increased nearly 90 percent. According to 

the PDMP Center for Excellence, these two data points 

indicate that the PDMP mandate suppresses inappropriate 

prescribing but does not impinge on legitimate prescribing.26 

PDMP utilization may also be a factor in reducing 

mortality associated with opioid use. A 2016 study of 

34 states (32 with PDMPs) found that the rate of opioidrelated deaths declined in states in the year after PDMP 

implementation. States whose PDMPs had more robust 

features (e.g., more frequently updated data) experienced 

greater reductions in deaths compared with states whose 

PDMPs did not have those features.27 

Ohio’s experience indicates that PDMPs can be a 

significant tool in a broader program to encourage and 

enforce safe prescribing practices. In 2011, the state 

adopted rules that mandate prescriber and dispenser 

use of the PDMP under certain conditions. At the same 

time, the state instituted other measures designed to curb 

misuse of prescription drugs, including crackdowns on 

pill mills (physicians, clinics, or pharmacies that prescribe 

or dispense controlled medications inappropriately or 

for nonmedical reasons), licensing restrictions on pain 

management clinics to prevent overprescription of opioid 

pain medications, and the institution of a drug take-back 

program. In the first quarter of 2014 alone, the PDMP 

received requests for 2 million reports.26 

A concern that has been raised about PDMPs is that they 

could suppress the availability of opioid medication for 

legitimate cases of pain. A 2016 study found that across 

24 states implementing PDMPs, a sustained 30 percent 

reduction in the rate of prescribing Schedule II opioids 

occurred; however, there was no significant impact on the 

overall prescribing of pain medication (the study did not 

evaluate whether patients’ pain was effectively managed).28 

One small study (N=179) of patients presenting with 

nonacute pain conditions in an emergency department 

found that in 41 percent of the cases, clinicians altered 

their prescribing plan after consulting the state’s PDMP; 

changes went in both directions, with the planned opioid 

prescribing reduced in 61 percent of the cases and 

increased in 39 percent.29 

Other initial studies indicate that PDMPs do not have a 

suppressive effect, although they may affect the types 

of opioids that are prescribed. A 2009 study found that, 

between 1997 and 2003, compared with states without 

PDMPs, states with PDMPs had a smaller number of 

shipments per capita (from suppliers to distributors such 

as pharmacies) for oxycodone (a medication highly 

associated with drug diversion) and reduced admissions 

for the treatment of prescription opioid misuse. At the 

same time, overall opioid shipments increased, indicating 

no chilling effect on the prescribing of opioids overall.30 

According to a study on Project Lazarus—a program in 

Wilkes County, NC, that combines PDMP surveillance 

data with public health education, prevention, and 

treatment efforts—overdose deaths in the county declined 

69 percent from 2009 to 2011, even though the number of 

opioid prescriptions remained nearly level and was higher 

than the state average.31 In a pilot study of the Indiana 

PDMP in 2012, physicians reported that the clinical care 
Behavioral Health Is Essential To Health • Prevention Works • Treatment Is Effective • People Recover

6 

In Brief

they provided was enhanced by use of PDMPs; depending 

on their patients’ clinical needs, physicians both reduced 

(by 58 percent) and increased (by 7 percent) the number of 

prescriptions written or number of pills dispensed.32 

Another concern is the perception that increased 

prescription monitoring through PDMPs may be a factor 

that causes people who are dependent on prescription 

opioids to switch to heroin use, contributing to heroinrelated overdose deaths (the rate of heroin-related deaths 

almost tripled from 2010 through 201333). However, 

according to an analysis of 2002–2011 data from the 

National Survey on Drug Use and Health, of people who 

initiate nonmedical use of pain relievers, only 3.6 percent 

transition to heroin use within 5 years of initiation.34 

According to the report Trends in Heroin Use in the United 

States: 2002 to 2013, “The concern that efforts to prevent 

the illegal use of prescription opioids are causing people 

to turn to heroin is not supported by the trend data. . . . 

Although research indicates that people who previously 

misused prescription pain relievers were more likely 

to initiate heroin use than people who had not misused 

prescription pain relievers, most people who misuse 

prescription pain relievers do not progress to heroin use.”35 

Furthermore, according to a 2016 review article,36 

implementation of most policy decisions aimed at reducing 

rates of nonmedical use of opioid medications occurred 

after heroin use rates had begun trending upward. The 

authors point to heroin’s increased accessibility, reduced 

price, and high purity as factors that may have contributed 

to increases in the drug’s use. In addition, the review 

highlighted studies of Florida and Staten Island, NY, that 

found that policy-induced reductions in the rates of opioid 

prescribing were associated with reductions in overall 

opioid-related deaths (that is, deaths related to either 

heroin or opioid medication use). Based on the overall 

findings of the review, the authors recommended enhanced 

use of PDMPs as part of a comprehensive strategy to 

reduce initiation of nonmedical opioid use. 

PDMPs as a Public Health 

Surveillance Tool 

Projects are in development to enhance use of state 

PDMPs for public health surveillance. Several states 

have provided PDMP information (typically with patientand prescriber-specific identification details hidden or 

removed) to researchers for the purpose of identifying 

trends in prescribing patterns.4 This type of aggregate 

information can be combined with health outcomes 

data—such as those compiled by emergency departments, 

medical examiners, poison control centers, and substance 

use treatment centers—to provide community-level risk 

data for use in planning community-level interventions.22 

Several federal agencies have coordinated with the 

PDMP Center of Excellence to establish the Prescription 

Behavior Surveillance System (PBSS). This is an early 

warning surveillance and evaluation tool that can analyze 

de-identified, population-based, longitudinal data from 

multiple states.37 PBSS data are being used to measure 

trends in controlled substance prescribing and to support 

educational initiatives for safe and appropriate prescribing. 

For example, one PBSS-based report, published in 2015, 

analyzed data from eight states representing one-fourth 

of the U.S. population.38 Among other trends, the analysis 

revealed the common practice of coprescribing opioids 

and benzodiazepines. This happens despite the fact that 

patients who concurrently use both types of medication 

face increased risk for potentially fatal overdose.2 

How Prescribers and Pharmacists 

Can Access PDMPs 

A healthcare provider must enroll in a PDMP to become 

an authorized user before obtaining access to its data. 

Typically, the enrollment procedure involves certifying 

credentials, authenticating providers through proper 

identification, and establishing secure system access 

through passwords and/or biomarkers. These procedures 

are intended to restrict entry to users with legitimate 

purposes for accessing the data. Several states have 

developed streamlined registration systems that make 

enrollment easier, while still maintaining confidentiality 

and security.4 

Related Recommendations for 

Healthcare Providers 

PDMP use complements other measures that providers 

can take to prevent misuse and diversion of prescription 

medications and to help ensure the safety of patients using 

them. Some of these measures are described below. 
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Prescription Drug Monitoring Programs: A Guide for Healthcare Providers

Winter 2017, Volume 10, Issue 1

Increase knowledge about substance use disorders 

and their prevention and treatment. Many prescribers 

have had little or no education on substance use disorder 

issues, either in professional school or through recurrent 

training.39,40 Furthermore, many prescribers are not 

educated or trained in prescribing practices that minimize 

risk with commonly misused medications.39,41 Less than 

half of the states have statutes or regulations that require or 

recommend education for prescribers of prescription pain 

medication.42 SAMHSA and other sources offer online 

learning opportunities on substance use disorders and 

related topics (see “Continuing education opportunities” in 

the Resources section of this document). 

Increase knowledge about safe opioid prescribing. 

According to the Food and Drug Administration (FDA),43 

obtaining training on opioid pharmacotherapy is one 

of three key actions prescribers can take to help curb 

the opioid public health crisis in the United States. The 

other two are reviewing and knowing the most current 

opioid drug labels and helping educate patients on using 

prescription opioids safely and effectively. Valuable 

information on this topic is available from CDC and 

other sources (see “Opioid prescribing resources” and 

“Continuing education opportunities”). 

Write prescriptions for controlled substances 

electronically. Electronic Prescriptions for Controlled 

Substances, a DEA initiative, permits electronic 

prescribing so long as both the prescriber and the dispenser 

use secure electronic health IT that meets DEA criteria.44 

Objectives of all electronic prescribing are to reduce 

opportunities for fraudulent prescriptions and better 

identify cases of misuse, improve efficiency and streamline 

prescriber workflow, inform clinical decision making, and 

improve patient safety by reducing adverse events. (See 

“Opioid prescribing resources.”) 

Become informed about risk-reduction strategies for 

opioid overdose. Providers can incorporate overdose 

prevention messages in their communications with patients 

who have prescriptions for controlled medication and 

with these patients’ caregivers. These messages can cover 

opioid risk and safety, potential side effects, signs of 

overdose, rescue breathing techniques, administration of 

naloxone (see next paragraph), and guidance on when to 

call 911. Providers can also consider developing a program 

policy for responding to onsite overdose. 

Become informed about the use of naloxone for 

treatment of opioid overdose. Available by prescription, 

naloxone is an opioid antagonist that is used to counter the 

effects of opioid overdose. The medication successfully 

reversed more than 26,000 overdoses between 1996 and 

2014.45 Wider distribution of naloxone, and more training in 

its use, could save many lives.46 The product is available in 

auto-injector and nasal spray formulations, which facilitate 

immediate administration by laypeople on the scene of 

an overdose, before emergency response professionals 

arrive.47 U.S. Department of Health and Human Services 

agencies, including SAMHSA, are working to expand 

distribution of naloxone to law enforcement agencies, 

emergency responders, prescribers, patients with opioid 

prescriptions, and individuals who have experienced an 

opioid overdose and their family members.48 Providers can 

consider having naloxone available in the office setting 

and prescribing naloxone to patients at risk for opioid 

overdose, including those being treated for pain. Through 

standing orders, collaborative practice agreements, and 

pharmacists’ prescriptive authority, states are making it 

substantially easier to gain access to naloxone.49 

The local department of public health can provide 

information about programs in the community that 

offer training on naloxone use. SAMHSA’s Opioid 

Overdose Prevention Toolkit provides information for first 

responders, treatment and service providers, and people 

recovering from opioid overdose. 

Recognize signals that a patient may be misusing 

prescription medications. Signs of prescription opioid 

misuse, for example, include presenting with vague 

complaints of pain, physical signs of acute intoxication, 

symptoms of withdrawal, low blood pressure, slowed 

heart rate, and respiratory depression.50 Patterns of 

behavior that may indicate prescription medication 

misuse include escalated use (e.g., running out of 

medication early, claiming to have lost a prescription and 

needing a refill), frequent emergency department visits 

in pursuit of prescriptions, or visits to clinics after hours 

or at busy times.51 Other warning signs are if the patient 

charms or pressures the practitioner into prescribing an 

opioid medication, particularly for a specific controlled 
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8 

In Brief

substance (that may have higher street value than generic 

equivalents); feigns illness but avoids a physical exam 

or diagnostic tests; uses other techniques to procure a 

prescription;51 or has a history of medication overdose. 

Identify patients with risky substance use behaviors 

and refer them to treatment. Before prescribing, 

providers should determine whether a patient has a history 

of substance misuse or whether he or she has risk factors 

associated with substance misuse. Providers should also 

try to provide support for people with suspicious patterns 

of prescription medication use, rather than terminating 

them as patients; these individuals may have substance 

use disorders requiring treatment. In addition, PDMP 

information that suggests a suspicious pattern of substance 

use should be cross-checked to ensure that it does not 

contain errors. Ways to encourage patients to adhere to 

safe prescription use include the following: 

■ Employ treatment agreements.

■ Regulate visit intervals.

■ Control the medication supply.

■ Conduct urine drug testing.

■ To the degree possible, include the patient’s support

network in monitoring efforts and coordinate care with

other providers.

Using a universal precautions approach, providers are 

encouraged to employ the safe prescribing practices listed 

above with all patients for whom they have prescribed 

controlled medication, not just those at obvious risk.52 

When treating patients with suspicious patterns of 

prescription medication use, providers can make clear 

that they will continue to provide care but will not enable 

medication misuse. SAMHSA’s TIP 54 provides guidance 

on managing opioid use disorder risk in patients treated 

with opioids.52 

Educate patients not to share medication prescribed to 

them. In the majority of instances in which people ages 

12 or older obtain prescription pain relievers for misuse 

(defined as “use in any way not directed by a doctor, 

including use without a prescription of one’s own; use in 

greater amounts, more often, or longer than told to take a 

drug; or use in any other way not directed by a doctor”53), 

they obtain it for free, buy it, or take it without asking from 

a friend or family member.6

 Usually, that friend or family 

member obtained the medication by prescription from 

one doctor (that is, through legitimate means). Patients 

receiving prescriptions should be counseled not to share 

their medications, because a medication appropriate for 

one individual may be inappropriate for another. Also, 

illicit use of prescription drugs can be as dangerous as use 

of illegal drugs, potentially leading to opioid use disorder, 

overdose, and/or death. 

Promote proper storage and disposal of prescription 

medications. Providers can advise patients to secure 

prescriptions with addiction potential in a locked box 

or cabinet. Providers can also encourage patients to 

follow disposal instructions on the drug label or patient 

information that accompanies a particular medication. 

FDA, in cooperation with the Office of National Drug 

Control Policy, has developed guidelines for medication 

disposal, which differ based on medication type. Many 

communities offer “take-back days” that allow the public 

to bring unused medication to a central location for proper 

disposal. On an ongoing basis, consumers may also bring 

or mail back unused prescription medication to locations 

authorized by DEA. Consumers can contact their local 

household trash and recycling service for information on 

their community’s take-back programs. (See “Medication 

disposal resources” for links to the FDA guidelines and 

DEA’s disposal information.) 

Conclusion 

PDMPs are an increasingly valuable and easy-to-use 

resource for healthcare providers who prescribe and 

dispense controlled medication. Regulation and oversight 

of these databases ensure that the benefits for clinical care 

do not jeopardize patient privacy and security. Providers 

are encouraged to register to use their state’s PDMP and 

to routinely query the database in regard to their patients’ 

prescription histories. This practice can help curtail 

prescription medication misuse and diversion, reduce risk 

of substance use disorders, and prevent opioid overdoses 

and deaths. 
Behavioral Health Is Essential To Health • Prevention Works • Treatment Is Effective • People Recover

9 

Prescription Drug Monitoring Programs: A Guide for Healthcare Providers

Winter 2017, Volume 10, Issue 1

Resources 

PDMP resources 

National Alliance for Model State Drug Laws 

www.namsdl.org/prescription-monitoring-programs.cfm 

National Association of State Controlled Substances 

Authorities 

www.nascsa.org/rxMonitoring.htm 

Prescription Drug Monitoring Program Training and 

Technical Assistance Center (the PDMP TTAC and the 

PDMP Center of Excellence have merged into a single 

program) 

www.pdmpassist.org 

Opioid prescribing resources 

Attention Prescribers: FDA Seeks Your Help in Curtailing 

the U.S. Opioid Epidemic 

www.fda.gov/downloads/Drugs/DrugSafety 

/InformationbyDrugClass/UCM330618.pdf 

CDC Guideline for Prescribing Opioids for Chronic Pain 

www.cdc.gov/drugoverdose/prescribing/guideline.html 

National Pain Strategy 

https://iprcc.nih.gov/docs/HHSNational_Pain_Strategy.pdf 

Electronic Prescriptions for Controlled Substances (EPCS) 

www.deadiversion.usdoj.gov/ecomm/e_rx 

The Extended-Release and Long-Acting Opioid Analgesics 

Risk Evaluation and Mitigation Strategy (provided by 

pharmaceutical companies as required by FDA, this 

website links to resources and accredited continuing 

education for healthcare providers) 

www.er-la-opioidrems.com 

Keeping Patients Safe: A Case Study on Using 

Prescription Monitoring Program Data in an Outpatient 

Addictions Treatment Setting 

www.pdmpassist.org/pdf/COE_documents/Add_to_TTAC 

/methadone_treatment_nff_%203_2_11.pdf 

VA/DoD Clinical Practice Guidelines, Management of 

Substance Use Disorders 

www.healthquality.va.gov/guidelines/MH/sud 

Medication disposal resources 

Drug Disposal Information 

www.deadiversion.usdoj.gov/drug_disposal 

How To Dispose of Unused Medicines 

www.fda.gov/ForConsumers/ConsumerUpdates 

/ucm101653.htm 

Continuing education opportunities 

HealtheKnowledge 

www.healtheknowledge.org 

Opioid and Pain Management Continuing Education 

www.drugabuse.gov/opioid-pain-management-cmesces 

OpioidPrescribing.org: Safe and Effective Opioid 

Prescribing for Chronic Pain 

www.opioidprescribing.com 

Providers’ Clinical Support System for Medication 

Assisted Treatment 

http://pcssmat.org 

Providers’ Clinical Support System for Opioid 

Therapies 

http://pcss-o.org 

SAMHSA’s Knowledge Application Program 

E-Learning Website (includes courses on prescription

medication misuse, abuse, dependence, and addiction)

https://kap-elearning.samhsa.gov

Relevant publications from SAMHSA 

(available through http://store.samhsa.gov) 

Opioid Overdose Prevention Toolkit 

Substance Abuse Treatment Advisory: OxyContin®: 

Prescription Drug Abuse—2008 Revision 

Substance Abuse Treatment Advisory: Prescription 

Medications: Misuse, Abuse, Dependence, and Addiction 

Treatment Improvement Protocol (TIP) 54: Managing 

Chronic Pain in Adults With or in Recovery From 

Substance Use Disorders 
Behavioral Health Is Essential To Health • Prevention Works • Treatment Is Effective • People Recover

10 

In Brief

Treatment referral resources 

SAMHSA’s National Helpline 

(24 hours a day, 365 days a year; English and Español) 

1-800-662-HELP (1-800-662-4357)

SAMHSA’s Behavioral Health Treatment 

Services Locator 

https://findtreatment.samhsa.gov 

American Society of Addiction Medicine, 

Membership Directory 

https://asam.ps.membersuite.com/directory 

/SearchDirectory_Criteria.aspx 

Notes 

1 Manchikanti, L. (2007). National drug control policy and prescription 

drug abuse: Facts and fallacies. Pain Physician, 10, 399–424. 

2 Centers for Disease Control and Prevention. (2016). CDC guideline 

for prescribing opioids for chronic pain—United States, 2016. 

MMWR Recommendations and Reports, 65(1), 1–50. 

3 U.S. Department of Health and Human Services. (2015, March). 

Opioid abuse in the U.S. and HHS actions to address opioid-drug 

related overdoses and deaths [Issue brief]. Retrieved December 2, 

2016, from https://aspe.hhs.gov/basic-report/opioid-abuse-us-and 

-hhs-actions-address-opioid-drug-related-overdoses-and-deaths

4 Clark, T., Eadie, J., Kreiner, P., & Strickler, G. (2012). Prescription 

drug monitoring programs: An assessment of the evidence for best 

practices. Waltham, MA: Brandeis University, Heller School for 

Social Policy and Management, Prescription Drug Monitoring 

Program Center of Excellence. 

5 Prescription Drug Monitoring Program Training and Technical 

Assistance Center. (n.d.). TTAC National Surveys: Analysis of 

data 2012 and 2014. Retrieved December 2, 2016, from 

http://pdmpassist.org/pdf/TTAC_2012_2014_Surveys_C.pdf 

6 Substance Abuse and Mental Health Services Administration. (2016). 

Results from the 2015 National Survey on Drug Use and Health: 

Detailed tables. Retrieved December 2, 2016, from 

www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2015 

/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015.pdf 

7 Substance Abuse and Mental Health Services Administration. (2012). 

The TEDS Report: Admissions reporting benzodiazepine and 

narcotic pain reliever abuse at treatment entry. Rockville, MD: 

Substance Abuse and Mental Health Services Administration. 

8 Hughes, A., Williams, M. R., Lipari, R. N., Bose, J., Copello, 

E. A. P., & Kroutil, L. A. (2016, September). Prescription drug use 

and misuse in the United States: Results from the 2015 National 

Survey on Drug Use and Health. NSDUH Data Review. Retrieved 

December 2, 2016, from www.samhsa.gov/data/sites/default/files 

/NSDUH-FFR2-2015/NSDUH-FFR2-2015.pdf 

9 Substance Abuse and Mental Health Services Administration. 

(2013, February 22). The DAWN Report: Highlights of the 2011 

Drug Abuse Warning Network (DAWN) findings on drug-related 

emergency department visits. Rockville, MD: Substance Abuse and 

Mental Health Services Administration. 

10 Centers for Disease Control and Prevention. (2015). Number and 

age-adjusted rates of drug-poisoning deaths involving opioid 

analgesics and heroin: United States, 1999–2014 [Mortality file]. 

Retrieved December 2, 2016, from www.cdc.gov/nchs/data 

/health_policy/AADR_drug_poisoning_involving_OA_Heroin 

_US_2000-2014.pdf 

11 Centers for Disease Control and Prevention. (2016). Increases in drug 

and opioid overdose deaths—United States, 2000-2014. Morbidity 

and Mortality Weekly Report, 64(50), 1378–1382. 

12 Centers for Disease Control and Prevention. (2016). Injury prevention 

and control: Opioid overdose [Webpage]. Retrieved December 2, 

2016, from www.cdc.gov/drugoverdose 

13 Centers for Disease Control and Prevention. (2012, July). Prescription 

painkiller overdoses: Use and abuse of methadone as a painkiller. 

CDC Vital Signs. 

14 Substance Abuse and Mental Health Services Administration. (2010). 

Data summary: Methadone mortality; A 2010 reassessment. 

Rockville, MD: Substance Abuse and Mental Health Services 

Administration. 

15 Prescription Drug Monitoring Program Center of Excellence. (2012). 

Real time reporting: Oklahoma’s pioneering PMP. Notes From the 

Field (NF 3.1). Waltham, MA: Brandeis University, Heller School 

for Social Policy and Management. 

16 U.S. Department of Health and Human Services. (2013). Prescription 

drug monitoring program interoperability standards: A report to 

Congress. Washington, DC: Author. 

17 Gunderson, C. (2014, September). Prescription drug monitoring 

programs (PDMPs): Indian Health Service update. Presentation at 

the Harold Rogers Prescription Drug Monitoring Program Annual 

Meeting. Retrieved December 2, 2016, from www.pdmpassist.org 

/pdf/PPTs/National2014/2-13_Thundercloud.pdf 

18 Prescription Drug Monitoring Program Training and Technical 

Assistance Center. (2015, October). U.S. Department of Veterans 

Affairs pharmacies reporting to PDMP. Retrieved December 2, 

2016, from www.pdmpassist.org/pdf/VA_pharmacies_reporting.pdf 

19 Prescription Drug Monitoring Program Training and Technical 

Assistance Center. (2013). Prescription drug monitoring program 

administrators guide for training law enforcement. Retrieved 

December 2, 2016, from http://pdmpassist.org/pdf/LE_USE_OF 

_PDMP_CURRICULUM_Final.pdf 

20 Centers for Disease Control and Prevention. (2016). CDC guideline 

for prescribing opioids for chronic pain—United States, 2016. 

MMWR Recommendations and Reports, 65(1), 16. 
Behavioral Health Is Essential To Health • Prevention Works • Treatment Is Effective • People Recover

11 

Prescription Drug Monitoring Programs: A Guide for Healthcare Providers 

21 Substance Abuse and Mental Health Services Administration. 

(2011, September 27). [Dear Colleague letter]. Retrieved 

December 2, 2016, from www.samhsa.gov/sites/default/files 

/programs_campaigns/medication_assisted/dear_colleague 

_letters/2011-colleague-letter-state-prescription-drug-monitoring 

-programs.pdf

22 Katz, N., Panas, L., Kim, M., Audet, A. D., Bilanksy, A., Eadie, J., 

et al. (2010). Usefulness of prescription monitoring programs for 

surveillance—Analysis of Schedule II opioid prescription data 

in Massachusetts, 1996–2006. Pharmacoepidemiology and Drug 

Safety, 19, 115–123. 

23 Cepeda, M. S., Fife, D., Berwaerts, J., Yuan, Y., & Mastrogiovanni, 

G. (2014). Shopping behavior for ADHD drugs: Results of a

cohort study in a pharmacy database. Drugs in Research and

Development, 14(3), 209.

24 Perrone, J., & Nelson, L. S. (2012). Medication reconciliation for 

controlled substances—An “ideal” prescription-drug monitoring 

program. New England Journal of Medicine, 366(25), 

2341–2343. 

25 Prescription Drug Monitoring Program Center of Excellence. 

(2014, September). Briefing on PDMP effectiveness. Retrieved 

December 2, 2016, from www.pdmpassist.org/pdf 

/COE_documents/Add_to_TTAC/Briefing%20on%20PDMP%20 

Effectiveness%203rd%20revision.pdf 

26 Prescription Drug Monitoring Program Center of Excellence. 

(2014, October). Mandating PDMP participation by medical 

providers: Current status and experience in selected states 

(Revision 2). Waltham, MA: Brandeis University, Heller School 

for Social Policy and Management. 

27 Patrick, S. W., Fry, C. E., Jones, T. F., & Buntin, M. B. (2016). 

Implementation of prescription drug monitoring programs 

associated with reductions in opioid-related death rates. Health 

Affairs, 35(7), 1324–1332. 

28 Bao, Y., Pan, Y., Taylor, A., Radakrishnan, S., Luo, F., Pincus, 

H. A., & Schackman, B. R. (2016). Prescription drug monitoring

programs are associated with sustained reductions in opioid

prescribing by physicians. Health Affairs, 35(6), 1045–1051.

29 Baehren, D. F., Marco, C. A., Droz, D. E., Sinha, S., Callan, E. M., & 

Akpunonu, P. (2010). A statewide prescription monitoring program 

affects emergency department prescribing behaviors. Annals of 

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30 Reisman, R. M., Shenoy, P. J., Atherly, A. J., & Flowers, C. R. (2009). 

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of state prescription drug monitoring program efficacy. Substance 

Abuse: Research and Treatment, 3, 41–51. 

31 Prescription Drug Monitoring Program Center of Excellence. (2012). 

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Waltham, MA: Brandeis University, Heller School for Social 

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Winter 2017, Volume 10, Issue 1 

32 U.S. Department of Health and Human Services. (2012). Connecting 

prescribers and dispensers to PDMPs through health IT: Six pilot 

studies and their impact. Washington, DC: Author. 

33 Hedegaard, H., Chen, L. H., & Warner, M. (2015). Drug-poisoning 

deaths involving heroin: United States, 2000–2013. NCHS Data 

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Statistics. 

34 Muhuri, P. K., Gfroerer, J. C., & Davies, C. (2013). Associations of 

nonmedical pain reliever use and initiation of heroin use in the 

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35 Lipari, R. N., & Hughes, A. (2015, April 23). The NSDUH Report: 

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36 Compton, W. M., Jones, C. M., & Baldwin, G. T. (2016). Relationship 

between nonmedical prescription-opioid use and heroin use. New 

England Journal of Medicine, 374, 154–163. 

37 Prescription Drug Monitoring Program Center of Excellence. 

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MA: Brandeis University, Heller School for Social Policy and 

Management. 

38 Centers for Disease Control and Prevention. (2015). Controlled 

substance prescribing patterns—Prescription behavior surveillance 

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39 U.S. Department of Health and Human Services. (2013). Addressing 

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future opportunities. Washington, DC: Author. 

40 Office of National Drug Control Policy. (2011). Epidemic: 

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41 Office of National Drug Control Policy. (2013). 2013 National Drug 

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42 Levi, J., Segal, L. M., & Miller, A. F. (2013). Prescription drug 

abuse: Strategies to stop the epidemic. Washington, DC: Trust for 

America’s Health. 

43 Food and Drug Administration. (2013, March 1). Attention 

prescribers: FDA seeks your help in curtailing the U.S. opioid 

epidemic [Letter]. Retrieved December 2, 2016, from 

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/InformationbyDrugClass/UCM330618.pdf 

44 Drug Enforcement Administration. (n.d.). Electronic prescriptions 

for controlled substances (EPCS): General questions and answers. 

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/ecomm/e_rx/faq/faq.htm 
In Brief

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In Brief, Prescription Drug Monitoring Programs: A Guide for Healthcare Providers

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53 Hughes, A., Williams, M. R., Lipari, R. N., Bose, J., Copello, 

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/default/files/NSDUH-FFR2-2015/NSDUH-FFR2-2015.pd

In Brief

This In Brief was written and produced under contract numbers 270-09-0307 and 270-14-0445 by the Knowledge Application 

Program (KAP), a Joint Venture of JBS International, Inc., and The CDM Group, Inc., for the Substance Abuse and Mental 

Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). Christina Currier and 

Suzanne Wise served as the Contracting Offic ’s Representatives, and Candi Byrne served as KAP Project Coordinator.

Disclaimer: The views, opinions, and content of this publication are those of the authors and do not necessarily reflect the

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Recommended Citation: Substance Abuse and Mental Health Services Administration. (2017). Prescription Drug 

Monitoring Programs: A Guide for Healthcare Providers. In Brief, Volume 10, Issue 1.

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Published 2017

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