A prescription drug monitoring program (PDMP), also known as a prescription monitoring program (PMP), is a computer database operated by a state’s government to track the prescribing of potentially dangerous medications. As of 2023, all 50 states and several U.S. territories have established PDMPs. In addition, most states require certain drugs, such as those on Schedules II, III, IV, and V of the federal Controlled Substance Act, to be tracked.
Basics of PDMPs
A PDMP is a tool used to help prevent substance use disorder. PDMPs are particularly important for legal but highly abused medications, such as oxycodone and hydrocodone. These opioids and others have become a national crisis due to their highly addictive nature. Thus, to address this crisis, all 50 states have created their own PDMPs. Missouri’s PDMP was the most recent addition, as it came online on December 13, 2023.
According to the Center for Disease Control and Prevention, effective PDMPs require frequent reporting of prescriptions and dispensations. Ideally, reporting takes place in real time, but requirements vary across states. Providers should be required to access the database before writing a prescription, and the database should be user-friendly and offer sub-accounts for mid-level practitioners. This encourages frequent use and reporting compliance.
Importance of PDMPs in Behavioral Health
PDMPs play a critical role in preventing prescription drug misuse and diversion, including in behavioral health settings. Typically, PDMP databases can be queried before an appointment, to check the patient’s drug history and recent prescriptions. This can serve as a “red flag” if the patient has a history of frequent controlled substance prescriptions. However, this will depend on whether these prescriptions align with the patient’s healthcare needs.
Using PDMPs can help you as a provider prevent new or recurring substance use disorders, and it can benefit public health by preventing prescribed drugs from ending up on the black market. Moreover, specific features of PDMPs that make them valuable tools for behavioral health practitioners include frequent reporting, batch reports, ease-of-use, electronic health records (EHR) software integrations, and the ability to track when prescriptions are filled.
Required PDMP Reporting
Most PDMPs require daily or less frequent reporting, but Oklahoma and Missouri (effective January 1, 2024) require real-time reporting, which is more effective at preventing substance abuse.
Key Information for Prescribing Physicians
PDMPs are highly relevant for prescribing physicians in behavioral health. Thanks to the DEA’s COVID-19 telemedicine rule extension, through December 31, 2024, many drugs can be prescribed on an initial 30-day basis via remote audio or audiovisual consultation.
These medications include AMBIEN®, Ativan®, ketamine (Spravato®), Valium®, and Xanax®. A key reason why the federal government can offer this flexibility is because of the effectiveness of state-level PDMP databases in preventing substance use disorder. PDMP reports include patient prescription history and potential red flags that can be used to inform treatment decisions and improve patient outcomes.
Reporting Requirements Under the DEA’s Telemedicine Rule
Prescribing physicians and staff should be aware that PDMP reporting is required under the telemedicine rule, and is increasingly required throughout the United States. In fact, only a handful of states still operating PDMPs on a voluntary reporting basis.
Navigating PDMPs in Practice
Each state operates its own PDMP, which means there is a wide range of variation in how PDMP computer interfaces are navigated, and which features are available and mandated. However, as of December 2023, 30 states and the District of Columbia use the same software: PMP AWARxE by Bamboo Health. This vendor also offers a clearinghouse where data can be submitted to multiple state PDMPs simultaneously, and a computer database called NarxCare, used by many major pharmacies, that aggregates data from numerous PDMPs into one system.
Using PDMPs with Your EHR
For behavioral health practices, another good option is using an EHR solution that integrates with PDMPs. Many behavioral health practitioners find, after registering and navigating their state’s PDMP system directly, that it is lacking in features. For example, automatic batch querying and submission of patient records, recurring checks (particularly as prescriptions are renewed), and integration with patients’ charts all make things easier. These features can help prevent substance abuse without causing undue burden on physicians, and are particularly helpful for e-prescribing.
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Ensuring Compliance and Best Practices
It is important to familiarize yourself and your staff with your state’s PDMP system along with laws, regulations, and potential consequences and penalties. Delegating access to mid-level practitioners and staff can help share the burden and ensure compliance, however, this can increase the risk of unauthorized disclosure of protected health information.
In fact, states vary widely on who is allowed access, with many only allowing a limited number of delegates with certain credentials (e.g., nurses; see pages 18–23 of this 2016 report). At all times, everyone with access to PDMP data should be trained on its use and confidentiality. Establish clear procedures to ensure that PDMP data is being checked for each patient and with the writing of each new prescription. In addition, new prescriptions should be reported in accordance with state and federal laws and regulations.
Depending on the jurisdiction, noncompliance can result in warnings, fines, licensure discipline or suspension, or even criminal prosecution.
Conclusion
Computerized PDMPs are a significant development in behavioral health medication management. There are many drugs that can be beneficial for behavioral health patients, but are also potentially dangerous controlled substances. Clinicians have an ethical obligation to do their part in preventing prescription drug abuse.
Effective integration of PDMPs into your practice can help you keep patient information front and center and file reports consistently and in a timely manner. The right EHR can can make a big difference towards this goal.
Prescribing physicians, especially, should stay informed about PDMP developments. To learn more about what a PDMP is and how PDMPs are helping prevent substance use disorder, see Prescription Drug Monitoring Programs: A Guide for Healthcare Providers (PDF from Substance Abuse and Mental Health Services Administration, 2017), and Leveraging PDMP Data in Overdose Prevention and Response (PDF from Center for Disease Control and Prevention, 2021).
References / Sources
https://www.dea.gov/drug-information/drug-scheduling
https://pdmp.mo.gov/
https://www.cdc.gov/drugoverdose/pdmp/index.html
https://www.ojp.gov/ncjrs/virtual-library/abstracts/prescription-drug-monitoring-program-oklahoma-state-profile
https://pmpclearinghouse.zendesk.com/hc/en-us/articles/21278906984851-Missouri-Real-Time-Reporting
https://www.federalregister.gov/documents/2023/10/10/2023-22406/second-temporary-extension-of-covid-19-telemedicine-flexibilities-for-prescription-of-controlled
https://pmpaware.net/
https://pmpclearinghouse.zendesk.com/hc/en-us/articles/4409701630995-How-To-Submit-Data-to-Multiple-States
https://bamboohealth.com/solutions/narxcare/
https://www.pewtrusts.org/~/media/assets/2016/12/prescription_drug_monitoring_programs.pdf
https://store.samhsa.gov/sites/default/files/sma16-4997.pdf
https://www.cdc.gov/drugoverdose/pdf/Leveraging-PDMPs-508.pdf
