In the United States, prescription monitoring programs (PMPs) or prescription drug monitoring programs (PDMPs) are state-run programs which collect and distribute data about the prescription and dispensation of federally controlled substances and, depending on state requirements, other potentially abusable prescription drugs. PMPs are meant to help prevent adverse drug-related events such as

opioid overdose An opioid overdose is toxicity due to excessive consumption of opioids, such as morphine, codeine, heroin, fentanyl, tramadol, and methadone. This preventable pathology can be fatal if it leads to respiratory depression, a lethal conditio ...

drug diversion Drug diversion is a medical and legal concept involving the transfer of a legally- prescribed controlled substance from the individual for whom it was prescribed to another person for any illicit use. The definition varies slightly among different ...

, and

substance abuse Substance misuse, also known as drug misuse or, in older vernacular, substance abuse, is the use of a drug in amounts or by methods that are harmful to the individual or others. It is a form of substance-related disorder, differing definition ...

by decreasing the amount and/or frequency of opioid prescribing, and by identifying those patients who are obtaining prescriptions from multiple providers (i.e., "doctor shopping") or those physicians overprescribing opioids. Most US health care workers support the idea of PMPs, which intend to assist

physician A physician, medical practitioner (British English), medical doctor, or simply doctor is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through the Medical education, study, Med ...

physician assistants A physician assistant or physician associate (PA) is a type of non-physician practitioner. While these job titles are used internationally, there is significant variation in training and scope of practice from country to country, and sometimes b ...

nurse practitioner A nurse practitioner (NP) is an advanced practice registered nurse and a type of mid-level practitioner. NPs are trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose disease, prescribe medications an ...

dentist A dentist, also known as a dental doctor, dental physician, dental surgeon, is a health care professional who specializes in dentistry, the branch of medicine focused on the teeth, gums, and mouth. The dentist's supporting team aids in provi ...

s and other prescribers, the

pharmacist A pharmacist, also known as a chemist in English in the Commonwealth of Nations, Commonwealth English, is a healthcare professional who is knowledgeable about preparation, mechanism of action, clinical usage and legislation of medications in ...

chemist A chemist (from Greek ''chēm(ía)'' alchemy; replacing ''chymist'' from Medieval Latin ''alchemist'') is a graduated scientist trained in the study of chemistry, or an officially enrolled student in the field. Chemists study the composition of ...

s and support staff of dispensing establishments. The database, whose use is required by State law, typically requires prescribers and pharmacies dispensing controlled substances to register with their respective state PMPs and (for pharmacies and providers who dispense from their offices) to report the dispensation of such prescriptions to an electronic online database. The majority of PMPs are authorized to notify law enforcement agencies or licensing boards or physicians when a prescriber, or patients receiving prescriptions, exceed thresholds established by the state or prescription recipient exceeds thresholds established by the State. All states have implemented PDMPs, although evidence for the effectiveness of these programs is mixed. While prescription of opioids has decreased with PMP use, overdose deaths in many states have actually increased, with those states sharing data with neighboring jurisdictions or requiring reporting of more drugs experiencing highest increases in deaths. This may be because those declined opioid prescriptions turn to street drugs, whose potency and contaminants carry greater overdose risk.

History

Prescription drug monitoring programs, or PDMPs, are an example of one initiative proposed to alleviate effects of the

opioid crisis The opioid epidemic, also referred to as the opioid crisis, is the rapid increase in the overuse, misuse or abuse, and Drug overdose, overdose deaths attributed either in part or in whole to the class of drugs called opiates or opioids since th ...

. The programs are designed to restrict prescription drug abuse by limiting a patient's ability to obtain similar prescriptions from multiple providers (i.e. “doctor shopping”) and reducing diversion of controlled substances. This is meant to reduce risk of fatal overdose caused by high doses of opioids or interactions between opioids and benzodiazepenes, and to enable better decision making on the part of healthcare providers who may be unaware of a patient's prescription drug use, history or other prescriptions. PDMPs have been implemented in state legislations since 1939 in California, a time before electronic medical records, though implementation increased with s awareness of overprescribing of opioids and overdose. A later New York state program was struck down by the U.S. Supreme Court in '' Whalen v. Roe''. But, by 2019, 49 states, the District of Columbia, and Guam had enacted PDMP legislation.Briefing on PDMP Effectiveness. (2014). In Prescription Drug Monitoring Program Center of Excellence At Brandeis (p. 13). Brandeis University . In 2021 Missouri, the last State to not use a PMP, adopted legislation to create one. PMPs are constantly being updated to increase speed of data collection, sharing of data across States, and ease of interpretation. This is being done by integrating PDMP reports with other health information technologies such as

health information exchange Health Information Exchange (HIE) is the electronic exchange of health care information across organizations within a region, community, or hospital system. Participants in this data exchange are collectively called Health Information Networks (HI ...

s (HIE),

electronic health record An electronic health record (EHR) is the systematized collection of electronically stored patient and population health information in a digital format. These records can be shared across different health care settings. Records are shared thro ...

(EHR) systems, and/ or pharmacy dispensing software systems. One program that has been implemented in nine states is called the PDMP Electronic Health Records Integration and Interoperability Expansion, also known as PEHRIIE. Another software, marketed by Bamboo Health and integrated with PMPs in 43 states, uses an algorithm to track factors thought to increase risk of diversion, abuse or overdose, and assigns patients a three digit score based on presumed indicators of risk. While some studies have suggested that PDMP-HIT integration and sharing of interstate data brings benefits such as reduced opioid-related inpatient morbidity, others have found no or negative impact on mortality compared to states without PMP data sharing. Patient and media reports suggest need for testing and evaluation of algorithmic software used to score risk, with some patients reporting denial of prescriptions without c explanation or clarity of data.

Goals

Most health care workers support PMPs which intend to assist

s and other prescribers, the

s and support staff of dispensing establishments, as well as

law-enforcement Law enforcement is the activity of some members of the government or other social institutions who act in an organized manner to enforce the law by investigating, deterring, rehabilitating, or punishing people who violate the rules and norms gove ...

agencies. The collaboration supports the legitimate medical use of controlled substances while limiting their abuse and diversion. Pharmacies dispensing controlled substances and prescribers typically must register with their respective state PMPs and (for pharmacies and providers who dispense controlled substances from their offices) report the dispensation to an electronic online database. Some pharmacy software can submit these reports automatically to multiple states.

Usage

List of programs by state

Software systems

NarxCare is a

prescription drug monitoring program In the United States, prescription monitoring programs (PMPs) or prescription drug monitoring programs (PDMPs) are state-run programs which collect and distribute data about the prescription and dispensation of federally controlled substances and, ...

(PDMP) run by

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. Bamboo Health was formerly known as Appriss. It is widely used across the

United States The United States of America (USA), also known as the United States (U.S.) or America, is a country primarily located in North America. It is a federal republic of 50 U.S. state, states and a federal capital district, Washington, D.C. The 48 ...

pharmacies Pharmacy is the science and practice of discovering, producing, preparing, dispensing, reviewing and monitoring medications, aiming to ensure the safe, effective, and affordable use of medication, medicines. It is a miscellaneous science as it ...

including

Rite Aid Rite Aid Corporation is an American drugstore chain based in Philadelphia, Pennsylvania. It was founded in 1962 in Scranton, Pennsylvania, by Alex Grass under the name Thrift D Discount Center. Prior to its first bankruptcy in 2023, it was the th ...

as well as those at

Walmart Walmart Inc. (; formerly Wal-Mart Stores, Inc.) is an American multinational retail corporation that operates a chain of hypermarkets (also called supercenters), discount department stores, and grocery stores in the United States and 23 other ...

and

Sam’s Club Sam's West, Inc. (doing business as Sam's Club) is a chain of membership-only warehouse club retail stores in the United States owned by Walmart. It was founded in 1983 and named after Walmart founder Sam Walton as Sam's Wholesale Club. , Sam's ...

. The NarxCare software allows doctors to view data about a patient, combining data from the prescription registries of various

U.S. state In the United States, a state is a constituent political entity, of which there are 50. Bound together in a political union, each state holds governmental jurisdiction over a separate and defined geographic territory where it shares its so ...

s to make the registries

interoperable Interoperability is a characteristic of a product or system to work with other products or systems. While the term was initially defined for information technology or systems engineering services to allow for information exchange, a broader de ...

nationally. It also uses

machine learning Machine learning (ML) is a field of study in artificial intelligence concerned with the development and study of Computational statistics, statistical algorithms that can learn from data and generalise to unseen data, and thus perform Task ( ...

to generate an "Overdose Risk Score" that potentially includes

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and criminal justice data; these scores have been criticized by

research Research is creative and systematic work undertaken to increase the stock of knowledge. It involves the collection, organization, and analysis of evidence to increase understanding of a topic, characterized by a particular attentiveness to ...

ers and patient advocates for the lack of transparency in the process as well as the potential for disparate treatment of

women A woman is an adult female human. Before adulthood, a female child or adolescent is referred to as a girl. Typically, women are of the female sex and inherit a pair of X chromosomes, one from each parent, and women with functional u ...

and

minority group The term "minority group" has different meanings, depending on the context. According to common usage, it can be defined simply as a group in society with the least number of individuals, or less than half of a population. Usually a minority g ...

s. Advertised as an "analytics tool and care management platform", the NarxCare software allows doctors to view data about a patient including how many pharmacies they have visited and the combinations of medication they are

prescribed A prescription, often abbreviated or Rx, is a formal communication from physicians or other registered healthcare professionals to a pharmacist, authorizing them to dispense a specific prescription drug for a specific patient. Historically, ...

. It combines data from the prescription registries of various

s, making the registries

nationally. It additionally uses

to generate various three-digit "risk scores" and an overall "Overdose Risk Score", collectively referred to as Narx Scores, in a process that potentially includes

and criminal justice data as well as court records.

Controversy

Many doctors and researchers support the idea of PDMPs as a tool in combatting the opioid epidemic. Opioid prescribing, opioid diversion and supply, opioid misuse, and opioid-related morbidity and mortality are common elements in data entered into PDMPs. Prescription Monitoring Programs are purported to offer economic benefits for the states who implement them by decreasing overall health care costs, lost productivity, and investigation times. However, there are many studies that conclude the impact of PDMPs is unclear. While use of PMPs has been accompanied by decrease in opioid prescribing, few analyses consider corresponding use of street opioids, extramedical use, or diversion, which might provide a more holistic method for evaluation of PMP intent and efficacy. Evidence for PDMP impact on fatal overdoses is decidedly mixed, with multiple studies finding increased overdose rates in some states, decreases in others, or no clear impact. Interestingly, an increase in heroin overdoses after PDMP implementation has been commonly reported, presumably as denial of prescription opioids sends patients in search of street drugs. Narx Scores have been criticized by

ers and patient advocates for the lack of transparency in the generation process as well as the potential for disparate treatment of

and

s. Writing in ''

Duke Law Journal The ''Duke Law Journal'' is a student-run law review and the premier legal periodical of Duke University School of Law. The journal publishes general-interest articles and student notes in eight issues each year. History and Overview The journ ...

'', Jennifer Oliva stated that "

black-box In science, computing, and engineering, a black box is a system which can be viewed in terms of its inputs and outputs (or transfer characteristics), without any knowledge of its internal workings. Its implementation is "opaque" (black). The te ...

algorithms" are used to generate the scores.