14 5. Improve and implement better prescription monitoring programs Laws in 49 of the 50 states support the creation of prescription drug monitoring programs (PDMPs), which require pharmacies to report to a state repository the sale of controlled substances in fulfillment of prescriptions. Most physicians who intend to prescribe an opioid for pain management therefore have the ability to determine if the patient has already gone to other physicians for the same or similar drugs, a practice sometimes referred to as doctor shopping. In addition, the system records all prior disbursement of controlled substances to the patient, so the prescribing physician has a more complete picture of prior medications that may be in conflict. It took a number of years for state legislatures to enable these monitoring programs, and there was a reluctance to share information across state lines, but this capability has now been implemented in several regions around the country. The PDMP concept is explained in detail in SAMHSA’s Guide for Healthcare Providers. Much of the funding for the creation of the PDMP network has come from the Bureau of Justice Assistance in the Office of Justice Programs at the U.S. Department of Justice under the Harold Rogers Prescription Drug Monitoring grant program.52 BJA has continued to fund improvements under this grant program and gives priority to funding state programs that introduce evidence- based practices to improve PDMP effectiveness. The need for a play to address these systems is founded in the extent to which physicians and pharmacies actually have access to and use the PDMPs. Some doctors are either unaware of the system, unsure of how to use it or have concerns about its accuracy. So the essence of this play is to undertake efforts to ensure that doctors know about and use their state system; that they check across states to ensure that a patient is not “doctor shopping;” and that the prescription history for prior medication does not indicate that a new prescription should not be written. The research on the impact of PDMPs is mixed. Because the policies requiring physicians to use a PDMP vary significantly across the states, it is difficult to conclude that the program directly prevents substance use disorder. However, in states where it is designed to motivate physicians and pharmacists to check with a PDMP before releasing controlled substances to the patient, the research shows a positive impact on reducing opioid use, which to some degree prevents the start of a substance use disorder.53 Acommonthemeinnumerousnationalandlocalinitiativesaddressingsubstanceuseordersincludesthestrengthening of these programs. States continue to upgrade and improve their PDMPs, including by: • creating algorithms in the PDMP system to automatically validate the prescription vs. prior prescriptions to detect over-subscribing or mistakes in dosages • mandating that pharmacies require patients to show identification prior to obtaining the medication • mandating the use of the PDMP system by prescribers and pharmacists The Prescription Drug Monitoring Program Training and Technical Assistance Center at Brandeis University has created a “Best Practices Checklist,” which outlines many of the improvements that have been identified to make PDMP usage more effective. Goals and Objectives The goal of a project to improve PDMP programs is to (1) ensure that the system does as much as possible to collect and make available data on past prescriptions and other indicators helpful to making decisions on prescriptions and (2) ensure that the system is used by physicians and pharmacists in dispensing controlled substances. While PDMPs are operated at the state level, local coalitions of interest can promote the inclusion and accessibility of the system to assure its maximum effectiveness. Greater use can be mandated legislatively, but also by efforts to educate and persuade physicians and pharmacists to take advantage of this effective tool. The PDMP instituted by the Bureau of Justice Assistance has published a presentation from SAMSHA that helps define goals for this work. Theory of Change Having an effective and accessible PDMP, and ensuring its use in the process of dispensing medications, will reduce the number of people who begin the development of a substance use disorder because they have been prescribed excessive amounts of opioid medication.