Our nation is experiencing a severe drug epidemic, driven in large part by the misuse of controlled substances. Over 100,000 people died from drug overdoses in 2022 alone and while these medications are effective for pain management and other medicinal uses, they also carry significant risks of addiction.
The challenge for providers is striking a balance between ensuring appropriate care and mitigating misuse. Prescription drug monitoring programs (PDMPs) support safe and responsible prescribing, opening access to patients’ drug histories to improve clinical decision-making and reduce the risk of misuse.
Explore how PDMPs can enhance your ability to prescribe controlled substances safely and confidently.
What Exactly Is a PDMP? (And Why Should You Care)
A Prescription Drug Monitoring Program (PDMP) is your digital safety net—an electronic database that tracks controlled substance prescriptions at the state level in real-time.
Think of it as a comprehensive patient medication passport that travels with them from provider to provider, pharmacy to pharmacy.
What PDMPs Track:
- Drug details: Name, strength, and quantity
- Provider information: Who prescribed what and when
- Pharmacy data: Where medications were filled
- Payment methods: Cash payments (often red flags)
- Prescription patterns: Timing, frequency, and overlaps
ISSUES PDMPs Help PREVENT:
- Doctor shopping - Multiple providers for the same medications
- Early refills - Requesting medications before they should run out
- Dangerous combinations - Overlapping prescriptions that could interact
- Diversion patterns - Suspicious prescribing or filling behaviors
UNDERSTANDING CONTROLLED SUBSTANCE SCHEDULes
Controlled substances can be highly addictive and carry safety risks for patients. The Controlled Substances Act established five drug schedules based on their medical value, the risk of addiction, and the ability to cause harm.
Schedule II: Highest Risk
These are the most strictly controlled prescription drugs. Examples include fentanyl, morphine, oxycodone, and Adderall. Doctors prescribe them to treat severe pain and ADHD, but they have high abuse potential. All Schedule II prescriptions must be tracked through monitoring programs to prevent misuse.
Schedule III: Moderate Risk
This group includes ketamine, anabolic steroids, and codeine combinations. These drugs treat pain and are used in anesthesia. They can be habit-forming, but the risk is mostly mental rather than physical addiction.
Schedule IV: Lower Risk
Common examples are anxiety medications like clonazepam, diazepam, and lorazepam. Doctors prescribe these for anxiety, seizures, and muscle problems. They have some abuse potential, but it's limited compared to higher schedules.
Schedule V: Lowest Risk
These include cough syrups with small amounts of codeine and some anti-diarrheal medicines. They have very low risk for misuse and are the easiest controlled substances to prescribe.
Schedule I
Schedule I drugs like heroin have no medical use and aren't prescribed by doctors. They're illegal and considered the most dangerous.
PDMP in Action: NarxCare
Many PDMPs use sophisticated scoring systems like NarxCare to help you quickly assess patient risk. Data in a NarxCare report acts as a helpful guide to support safe prescribing based on a patient's use of certain controlled substances compared to their home state’s PDMP population.
What Is a Narx Score?
The NarxCare report generates associated NarxCare Scores to help providers accurately determine a patient's risk related to controlled substance use. NarxCare Scores are broken into substance-specific and risk categories:
- Narcotic
- Sedative
- Stimulant
- Unintentional overdose risk
Scores range from 000 to 999, with higher numbers correlating to increased risks of overdose or misuse. They are based on the number of prescribers and pharmacies involved, overlapping prescriptions, co-prescribed drugs, the dosage, and quantity dispensed.
The first two digits of each Narx Score show how a patient's drug use compares to others in the same state, with higher numbers relating to higher use or risk. The last digit indicates the number of active prescriptions in that category. For example, a Narx Score of 234 means the patient is in the 23rd percentile of use and currently has four active narcotic prescriptions.
Regulatory Pressure and Stewardship
The prescription of opioids peaked in 2011, but prescription drug abuse remains an epidemic. Monitoring the prescribing and distribution of controlled substances is vital because of the potential for abuse and misuse.
Regulations to Navigate
While specific regulations differ at the state level, all 50 states have a PDMP available—most of which require reporting. This may mean daily or frequent reporting—and some states, such as Oklahoma and Missouri, even require real-time reporting. Depending on the jurisdiction, noncompliance can result in warnings, fines, licensure discipline or suspension, or even criminal prosecution.
Furthermore, per the Drug Enforcement Agency’s Telemedicine Rules, telemedicine platforms in particular must register with the DEA and establish a PDMP to protect against controlled substance abuse and diversion. These measures will improve drug safety and give pharmacists and medical practitioners visibility into patients’ medication history.
Compliance Consequences
Non-compliance can result in more than just a slap on the wrist. Consequences can include:
- Official warnings
- Financial penalties
- License discipline or suspension
- Potential criminal prosecution
Beyond Compliance: The Public Health Impact
PDMPs aren't just about individual patient safety—they're powerful public health tools. State health departments use PDMP data to:
- Monitor Trends
- Track opioid misuse outbreaks
- Inform public health interventions
- Develop targeted prevention policies
- Allocate treatment resources effectively
The Game Changer: EHR Integration
THE OLD WAY: A PROVIDER'S NIGHTMARE
Without integration, healthcare providers face a daily struggle with fragmented systems. Picture logging into separate state databases for each patient, re-entering the same information multiple times, and manually cross-referencing data across platforms. This tedious process not only increases the risk of input errors but steals precious time away from what matters most—patient care.
Clinical Benefits: Better Care, Better Decisions
EHR integration changes everything at the point of care. Providers gain instant access to comprehensive medication histories in one unified view, enabling real-time decision-making when it matters most. The system automatically flags potential drug interactions before prescribing and creates valuable opportunities for early addiction detection and intervention.
Workflow Benefits: Efficiency Redefined
Gone are the days of juggling multiple logins and manual data entry. Single sign-on access eliminates separate database logins, while automated data retrieval removes the need for manual lookups entirely. Documentation syncs automatically with medical records, delivering substantial time savings that let providers focus on patients rather than paperwork.
Compliance Benefits: Automated Protection
Integration builds regulatory compliance directly into your workflow. The system performs mandatory checks automatically before prescribing, creates audit trails for regulatory review, and enables interstate data sharing for comprehensive coverage. This automated approach significantly reduces legal exposure through proper documentation protocols.
Patient Safety Benefits: Protection at Every Level
Most importantly, integrated PDMPs enhance patient safety across multiple fronts. The system helps prevent doctor shopping and prescription diversion while creating opportunities for enhanced patient education. Providers can coordinate care more effectively among multiple team members and monitor medication adherence with greater precision.
This comprehensive integration transforms PDMP from a simple compliance requirement into a powerful clinical tool that enhances both provider efficiency and patient outcomes.
Improve Care Delivery and Patient Safety with Juno EHR
Prescription drug monitoring programs create a layer of safety around controlled substances. With PDMP access directly inside your EHR, you achieve the freedom to streamline and improve clinical workflows and decision-making on demand.
Juno EHR’s e-Prescribing offers fully integrated, real-time PDMP access across all 50 states, so you can ensure medication adherence and identify risks. Discover how e-Prescribing with Juno EHR can support safer prescribing and better patient outcomes.
