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 overdoses, drug diversion, and substance abuse 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 physicians, physician assistants, nurse practitioners, dentists and other prescribers, the pharmacists, chemists 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 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.Department of Health. (n.d.). Retrieved from https://www.health.ny.gov/community/opioid_epidemic

PDMPs have been implemented in state legislations since 1939 in California, a time before electronic medical records, though implementation rose alongside increased 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.Thielking, M., Ross, C., Branswell, H., Hogan, A., & Associated Press. (2017, March 7). Missouri is the only state not tracking prescription drug use. Here’s why. Retrieved January 24, 2019, from https://www.statnews.com/2017/03/07/missouri-prescription-drug-database/

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 exchanges (HIE), electronic health record (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 physicians, physician assistants, nurse practitioners, dentists and other prescribers, the pharmacists, chemists and support staff of dispensing establishments, as well as law-enforcement 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.Pharmacist's Manual. (n.d.). Retrieved from https://www.deadiversion.usdoj.gov/pubs/manuals/pharm2/pharm_content.htm

Usage

List of programs by state State Name State Code Format Method Reporting Agency Schedules Monitored Documentation State Frequency Data RetentionAlaska AK ASAP 2009 v4.1 sFTP Appriss:855-525-4767 2 - 5 Source Monthly 2 SourceAlabama AL ASAP 2007 v4.0 sFTP Health Information Design Phone: 334.502.3262 2 - 5 Source Daily ?Arkansas AR ASAP 2011 v4.2 sFTP Health Information Design Phone: 334.502.3262 ? ? Weekly ?Arizona AZ ASAP 2011 v4.2 sFTP Health Information Design Phone: 334.502.3262 2 - 4 + Carisoprodol Source Daily Adult 6 / Minor 3 SourceCalifornia CA ASAP 2009 v4.1 sFTP Atlantic Associates, Inc Phone: 800.539.3370 2 - 4 Source Weekly 3 SourceColorado CO ASAP 2012 v4.2 sFTP Health Information Design Phone: 334.502.3262 2 - 5 Source Bi-Weekly ?Connecticut CT ASAP 4.2 FTPs Appriss:855-525-4767 2 - 5 Source Bi-Weekly ? District of Columbia DC ASAP 4.2 ? ? ? ? ? ?Delaware DE ASAP 2011 v4.2 sFTP Health Information Design Phone 334.502.3262 2 - 5 Daily ? Florida FL ASAP 2009 v4.2 sFTP Health Information Design Phone: 334.502.3262 2 - 4 Source Weekly ?Georgia GA ASAP 2011 V4.2 ? Appriss:855-525-4767 ? ? ? 1 SourceHawaii HI ASAP 2009 v4.2 Web Portal Appriss:855-525-4767 2 - 5 + Carisoprodol Source Weekly https://hipdmpreporting.hidinc.com/Idaho ID ASAP 2009 v4.1 sFTP Appriss:855-525-4767 2 - 5 Source Weekly ?Illinois IL ASAP 2007 v4.0 sFTP Atlantic Associates, Inc Phone: 800.539.3370 2 - 5 Source Weekly 2 SourceIndiana IN ASAP 2007 v4.2 FTPs INSPECT Phone: 317.234.4458 Phone:866.683.2476 2 - 5 + Carisoprodol (SOMA) Daily ?Iowa IA ASAP v4.1 FTPs Optimum Technology, Inc Phone: 866.683.2476 2 - 4 Source Bi-Weekly 4 SourceKansas KS ASAP 2009 v4.1 sFTP Appriss:855-525-4767 2 - 4 + Drugs of Concern Source Daily ?Kentucky KY ASAP 2009 v4.1 sFTP Health Information Design Phone: 334.502.3262 2 - 5 + Carisoprodol, Tramadol Source Daily 5 SourceLouisiana LA ASAP 4.2 sFTP Appriss:855-525-4767 2 - 5 + Tramadol, Butalibtal, Carisoprodol, Ephedrine, Pseudoephedrine, PPA Source Weekly ?Massachusetts MA ASAP 2009 v4.1 sFTP Appriss:855-525-4767 2 - 5 Source Weekly ?Maryland MD ASAP 2011 V4.2 sFTP Health Information Design Phone: 334.502.3262 2 - 4 Source Weekly ?Maine ME ASAP 2009 v4.1 sFTP Appriss:855-525-4767 2 - 4 Source Bi-Weekly 6 SourceMichigan MI ASAP 2009 v4.1 Web Portal Michigan Automated Prescription System (MAPS) Source 2 - 5 Source Bi-Weekly ?Minnesota MN ASAP 2007 v4.0 sFTP Health Information Design Phone: 334.502.3262 2 - 4 + Codeine containing cough syrups that are schedule 5 federally are schedule 3 in MN; Human growth hormones are schedule 3 in MN. Source Daily 1 SourceMissouri MO ASAP 4.2 ? ? ? ? ? 3 SourceMississippi MS ASAP 2005 v3.0 sFTP Appriss:855-525-4767 2 - 5 + Butalbital, Carisoprodol, Soma, Tramadol Powder, Ultracet, Ultram ER, Ryzolt ER. Weekly ? Montana MT ASAP 4.2 sFTPMontana Prescription Drug Registry ? ? Weekly ?North Carolina NC ASAP 4.2 sFTP Health Information Design Phone: 334.502.3262 2 - 5 Source Weekly 6 SourceNorth Dakota ND ASAP 2009 v4.1 sFTP Health Information Design Phone: 334.502.3262 2 - 5 + Tramadol, Carisoprodol Source Daily ?Nebraska NE ASAP 4.2 ? ? ? ? ? ?New Hampshire NH ASAP 4.2 sFTP Appriss:855-525-4767 2 - 5 + Tramadol, Carisoprodol nhpdmpreporting.hidinc.com Daily ?New Jersey NJ ASAP 2009 v4.1 sFTP Appriss:855-525-4767 2 - 5 and HCG Weekly ? New Mexico NM ASAP 2009 v4.1 Web Portal Appriss:855-525-4767 2 - 4 + Butalbital (Fioricet), Carisoprodol (Soma), Dezocine (Dalgan), Flunitrazepam (Rohypnol), Nalbuphine (Nubain), Pseudoephedrine (Sudafed) Source Weekly ? Nevada NV ASAP 2005 v3.0 sFTP Appriss:855-525-4767 2 - 4 + Carisoprodol Source Weekly ? New York NY ASAP 2007 v4.0 Web Portal New York (DOH & BNDD) Phone: 866.811.7957 2 - 5 + Chorionic Gonadotropin, HCG Source Daily 5 SourceOhio OH ASAP 2009 v4.1 sFTP Ohio Automated Rx Reporting System (OARRS) Phone: 614.466.4143 2 - 5 + Carisoprodol, Tramadol Source Daily 2 SourceOklahoma OK ASAP 2019 v4.2b Web Service Appriss:855-525-4767 2 - 5 + Tramadol Source Within 5 Minutes ?Oregon OR ASAP 2009 v4.1 sFTP Health Information Design Phone: 334.502.3262 2 - 4 ? Weekly 3 SourcePennsylvania PA ASAP 2007 v4.0 FTPs Appriss:855-525-4767 2 + ephedrine, pseudoephedrine, phenylpropanolamine, PSE ? Monthly ?Rhode Island RI ASAP 4.2 Web Portal Prescription Monitoring Program (PMP) Phone: 401.222.2840 2 - 3 Source Monthly ?South Carolina SC ASAP 4.2 sFTP Appriss:855-525-4767 2 - 4 Source Monthly ?South Dakota SD ASAP 2009 v4.1 sFTP Appriss:855-525-4767 2 - 4 ? Weekly ?Tennessee TN ASAP 2009 v4.1 FTPs Optimum Technology, Inc Phone: 866.683.2476 2 - 5 Source Bi-Weekly ?Texas TX ASAP 2009 v4.1 FTPs Appriss:855-525-4767 2 - 5 + Carisoprodol Source Bi-Weekly 1 SourceUtah UT ASAP 4.2 Web Portal Utah Controlled Substance Database Program Phone: 801.530.6232 2 - 5 + butalbital w/acetaminophen Source Daily UCA 58-37fVirginia VA ASAP 2009 v4.1 FTPs Appriss:855-525-4767 2 - 4 Source Bi-Weekly ?Vermont VT ASAP 2005 v3.0 sFTP Appriss:855-525-4767 2 - 4 ? Weekly 6 SourceWashington WA ASAP 2011 v4.2 sFTP Health Information Design Phone: 334.502.3262 2 - 5 Source Weekly ?Wisconsin WI ASAP 2011 v4.2 ? ? 2-5 + Tramadol ? ? ?West Virginia WV ASAP 4.2 Web Portal West Virginia Board of Pharmacy 2 -4 Source ? ?Wyoming WY ASAP 4.2 sFTP Atlantic Associates, Inc. Phone: 800.539.3370 2 - 4 + Tramadol, Carisoprodol Source Weekly ?

Software systems

NarxCare is a prescription drug monitoring program (PDMP) run by Bamboo Health. Bamboo Health was formerly known as Appriss. It is widely used across the United States by pharmacies including Rite Aid as well as those at Walmart and Sam’s Club. The NarxCare software allows doctors to view data about a patient, combining data from the prescription registries of various U.S. states to make the registries interoperable nationally. It also uses machine learning to generate an "Overdose Risk Score" that potentially includes EMS and criminal justice data; these scores have been criticized by researchers and patient advocates for the lack of transparency in the process as well as the potential for disparate treatment of women and minority groups.