	Introduction

In the midst of national concern over the opioid epidemic and the large number of prescription opioid overdose deaths in the United States, federal and state officials are paying greater attention to the manner in which opioids are prescribed. Most prescription drugs that are misused are originally prescribed by a physician (rather than, for example, being stolen from pharmacies); therefore, attention has been directed toward preventing the diversion of prescription drugs after the prescriptions are dispensed. Prescription drug monitoring programs (PDMPs) maintain statewide electronic databases of dispensed prescriptions for controlled substances. Possible uses of PDMPs include
identifying or preventing drug abuse and diversion; facilitating the identification of prescription drug-addicted individuals and appropriate intervention and treatment; outlining use and abuse trends to inform public health initiatives; and educating individuals about prescription drug use, abuse, and diversion. As of February 2018, 50 states, the District of Columbia, and two territories (Guam and Puerto Rico) had operational PDMPs within their borders. Each state also determines which entities dispensing prescriptions for controlled substances are required to submit data to the PDMP. Interstate Information Sharing and Interoperability

State PDMPs vary widely with respect to whether or how information contained in the database is shared with other states. The overarching finding was that costs vary widely, with program startup costs ranging from $450,000 to over $1.5 million. PDMP financing often involves monies from the state general fund, prescriber and pharmacy licensing fees, state controlled substance registration fees, health insurers' fees, direct-support organizations, state or federal grants, or a combination thereof. The author concluded that PDMPs reduce "doctor shopping," change prescribing behavior, and reduce prescription drug abuse. Another potential unintended consequence of a state PDMP is that it may push drug diversion activities over the border into a neighboring state. Federal Programs that Support State PDMPs

The federal government supports state PDMPs through programs at the Departments of Justice (DOJ) and Health and Human Services (HHS). Since FY2002, DOJ has administered the Harold Rogers Prescription Drug Monitoring Program, and in FY2017, DOJ incorporated this grant program into the new Comprehensive Opioid Abuse Program. HHS programs include the National All Schedules Prescription Electronic Reporting (NASPER), State Demonstration Grants for Comprehensive Opioid Abuse Response, Opioid Prevention in States grants, and various pilots and initiatives under the Office of the National Coordinator for Health Information Technology (ONC). NASPER grants were last funded in FY2010. 2. Selected Policy Issues

		Role of PDMPs in Federal Efforts to Address Prescription Drug Abuse

In 2011, in response to the "epidemic" of prescription drug abuse, the Obama Administration released an action plan. Specific actions offered included
working with states to establish effective PDMPs by encouraging research on PDMP effectiveness and means to improve PDMP effectiveness; supporting the NASPER reauthorization; ensuring that the Department of Veterans Affairs (VA) and the Department of Defense (DOD) are authorized to share patient information with state PDMPs; encouraging federally funded health care programs to provide controlled substance prescription information to the state PDMPs (in states where they operate health care facilities or pharmacies); exploring the feasibility of reimbursing prescribers for checking PDMPs before writing controlled substance prescriptions to patients covered under insurance plans; evaluating programs that require certain doctor shoppers or drug abusing individuals to use one doctor and one pharmacy; evaluating the potential for state PDMPs to reduce Medicare and Medicaid fraud; issuing a final rule from DEA on electronic prescribing of controlled substances; increasing the use of "Screening, Brief Intervention, and Referral to Treatment" programs to identify and prevent prescription drug abuse; identifying how health information technologies can enhance prescription drug information; testing the usefulness of the Centers for Disease Control and Prevention's surveillance system to generate measures of prescription drug abuse; assessing the use of the Drug Abuse Warning Network to better understand prescription drug abuse at the community level; expanding DOJ's efforts to enhance interstate PDMP interoperability, particularly though the PMIX program; and evaluating existing databases with information on prescription drug access, use, misuse, and toxicity to improve their utility and as new sources of data. Balancing Stakeholder Concerns

While establishment and enhancement of PDMPs (such as interstate data sharing and real-time data access) enjoy broad support, some stakeholders express concerns about health care versus law enforcement uses of PDMP data, particularly with regard to protection of personally identifiable health information. Federal Role in Interstate Information Sharing and Interoperability

Federal policymakers have repeatedly emphasized the importance of enhancing interstate information sharing and the interoperability of state systems. In November 2017, a presidential commission recommended, among other things, that the Trump Administration support legislation to require DOJ to fund a "data-sharing hub" and require states receiving federal grant funds to share PDMP data.
In the midst of national concern over the opioid epidemic, federal and state officials are paying greater attention to the manner in which opioids are prescribed. Nearly all prescription drugs involved in overdoses are originally prescribed by a physician (rather than, for example, being stolen from pharmacies). Thus, attention has been directed toward better understanding how opioids are being prescribed and preventing the diversion of prescription drugs after the prescriptions are dispensed.
Prescription drug monitoring programs (PDMPs) maintain statewide electronic databases of prescriptions dispensed for controlled substances (i.e., prescription drugs with a potential for abuse that are subject to stricter government regulation). Information collected by PDMPs may be used to educate and inform prescribers, pharmacists, and the public; identify or prevent drug abuse and diversion; facilitate the identification of prescription drug-addicted individuals and enable intervention and treatment; outline drug use and abuse trends to inform public health initiatives; or educate individuals about prescription drug use, abuse, diversion, and PDMPs themselves.
As of February 2018, 50 states, the District of Columbia, and two territories (Guam and Puerto Rico) had operational PDMPs within their borders.
How PDMPs are organized and operated varies among states. Each state determines which agency houses the PDMP; which controlled substances must be reported; which types of dispensers (e.g., pharmacies) are required to submit data; how often data are collected; who may access information in the PDMP database (e.g., prescribers, dispensers, or law enforcement); the circumstances under which the information may (or must) be accessed; and what enforcement mechanisms are in place for noncompliance.
PDMP costs may vary widely, with startup costs that can range as high as $450,000 to over $1.5 million and annual operating costs ranging from $125,000 to nearly $1.0 million. States finance PDMPs using monies from a variety of sources including the state general fund, prescriber and pharmacy licensing fees, state controlled substance registration fees, health insurers' fees, direct-support organizations, state grants, and/or federal grants.
The federal government supports state PDMPs through programs at the Departments of Justice (DOJ) and Health and Human Services (HHS). Since FY2002, DOJ has administered the Harold Rogers Prescription Drug Monitoring Program, and in FY2017, DOJ incorporated this grant program into the new Comprehensive Opioid Abuse Program. HHS programs include National All Schedules Prescription Electronic Reporting (NASPER), State Demonstration Grants for Comprehensive Opioid Abuse Response, Opioid Prevention in States grants, State Targeted Response to the Opioid Crisis Grants, and various pilots and initiatives under the Office of the National Coordinator for Health Information Technology (ONC). Of note, NASPER last received appropriations (of $2.0 million) in FY2010.
State PDMPs vary with respect to whether or how information contained in the database is shared with other states. Federal policymakers have repeatedly emphasized the importance of enhancing interstate information sharing and the interoperability of state PDMPs. In 2011, the Obama Administration included efforts to increase interstate data sharing in its action plan to counter prescription drug abuse. In 2017, a presidential commission recommended, among other things, that the Trump Administration support legislation to require DOJ to fund a "data-sharing hub" and require states receiving federal grant funds to share PDMP data.
The available evidence suggests that PDMPs can be effective in reducing the time required for drug diversion investigations, changing prescribing behavior, reducing "doctor shopping," and reducing prescription drug abuse. Assessments of effectiveness should also take into consideration potential unintended consequences of PDMPs, such as limiting access to medications for legitimate use or pushing drug diversion activities over the border into a neighboring state. Experts suggest that PDMP effectiveness might be improved by increasing the timeliness, completeness, consistency, and accessibility of the data.
Policy issues that might come before Congress include the role of state PDMPs in federal efforts to combat prescription drug abuse, the role of the federal government in interstate data-sharing and interoperability, and the possible link between the crackdown on prescription drug abuse and the uptick in illicit opioid (e.g., heroin and illicit fentanyl) abuse. While establishment and enhancement of PDMPs enjoy relatively broad support, stakeholders express concerns about health care versus law enforcement uses of PDMP data (particularly with regard to protection of personally identifiable health information).