The ways in which prescription drug monitoring programs (PDMPs) have been integrated into clinical practice remain understudied, and research into PDMP implementation in states where PDMP use by providers is mandated remains scant. This qualitative study describes how use of a state-mandated PDMP influenced clinical practice and opioid analgesic prescribing. We conducted face-to-face, in-depth interviews with 53 New York State-licensed primary care physicians who reported that they currently prescribed opioid analgesic medication, including those providers who reported consistent use of the PDMP (n = 38) in this sample. We used a thematic analytic approach to identify patterns of PDMP implementation into practice following enactment of the New York State legislative usage mandate. Among physicians who consistently used the PDMP, we found two distinct groups: (1) physicians who reported no change in their clinical practice and (2) physicians who acknowledged changes to both clinical practice and administrative management. In the latter group, most physicians felt the PDMP had benefited their patient relationships by fostering dialogue around patient substance use; however, some used the PDMP to dismiss patients from care. Findings suggest that increased education for providers relating to judicious prescribing, opioid use disorder, and best practice for PDMP utilization are needed.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Center for Behavioral Health Statistics and Quality. Results from the 2019 National Survey on Drug Use and Health: Detailed tables. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2020.
Scholl L, Seth P, Kariisa M, et al. Drug and Opioid-Involved Overdose Deaths - United States, 2013-2017. MMWR Morbidity and Mortality Weekly Report. 2018;67(5152):1419-1427.
Centers for Disease Control and Prevention. 2018 Annual Surveillance Report of Drug-Related Risks and Outcomes — United States. Atlanta, GA: CDC; 2018.
Levy B, Paulozzi L, Mack KA, et al. Trends in Opioid Analgesic-Prescribing Rates by Specialty, U.S., 2007–2012. American Journal of Preventive Medicine. 2015;49(3):409–413.
Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016. MMWR Morbidity and Mortality Weekly Report. 2016 Mar 18;65(1):1-49.
Finklea K, Sacco LN, Bagalman E. Prescription Drug Monitoring Programs. R42593. Washington, DC: Congressional Research Service; 2014.
Clark, T., Eadie, J., Kreiner, P., et al. Prescription drug monitoring programs: An assessment of the evidence for best practices. Boston, MA: Prescription Drug Monitoring Program Center of Excellence, Brandeis University Heller School of Social Policy and Management; 2012.
Brandeis University, Prescription Drug Monitoring Program Training and Technical Assistance Center. PDMP policies and capabilities. Available at: https://www.pdmpassist.org/Policies/Maps/PDMPPolicies. No date. Accessed October 15, 2020.
Prescription Drug Monitoring Program Center for Excellence. Prescription drug monitoring program mandatory enrollment and use of PDMPs. Available at: https://www.pdmpassist.org/pdf/TAG_Mandatory_Enrollment_Use_20200710.pdf. Accessed November 16, 2020. Updated July 2020.
Bao Y, Pan Y, Taylor A, et al. Prescription Drug Monitoring Programs Are Associated With Sustained Reductions In Opioid Prescribing By Physicians. Health Affairs. 2016;35(6):1045-1051.
Chang HY, Lyapustina T, Rutkow L, et al. Impact of prescription drug monitoring programs and pill mill laws on high-risk opioid prescribers: A comparative interrupted time series analysis. Drug and Alcohol Dependence. 2016;165:1-8.
Ali MM, Dowd WN, Classen T, et al. Prescription drug monitoring programs, nonmedical use of prescription drugs, and heroin use: Evidence from the National Survey of Drug Use and Health. Addictive Behaviors. 2017;69:65-77.
Centers for Disease Control and Prevention. Checking the PDMP: An Important Step to Improving Opioid Prescribing Practices. Available at: https://www.cdc.gov/drugoverdose/pdf/pdmp_factsheet-a.pdf. Updated August 30, 2017. Accessed October 10, 2017.
Rutkow L, Smith KC, Lai AY, et al. Prescription drug monitoring program design and function: A qualitative analysis. Drug and Alcohol Dependence. 2017;180:395-400.
Strickler GK, Zhang K, Halpin JF, et al. Effects of mandatory prescription drug monitoring program (PDMP) use laws on prescriber registration and use and on risky prescribing. Drug and Alcohol Dependence. 2019;199:1-9.
Stucke RS, Kelly JL, Mathis KA, et al. Association of the Use of a Mandatory Prescription Drug Monitoring Program With Prescribing Practices for Patients Undergoing Elective Surgery. JAMA Surgery. 2018;153(12):1105-1110.
Shev AB, Wintemute GJ, Cerdá M, et al. Prescription Drug Monitoring Program: Registration and Use by Prescribers and Pharmacists Before and After Legal Mandatory Registration, California, 2010-2017. American Journal of Public Health. 2018;108(12):1669-1674.
Hildebran C, Cohen DJ, Irvine JM, et al. How clinicians use prescription drug monitoring programs: a qualitative inquiry. Pain Medicine. 2014;15(7):1179-1186.
Leichtling GJ, Irvine JM, Hildebran C, et al. Clinicians' Use of Prescription Drug Monitoring Programs in Clinical Practice and Decision-Making. Pain Medicine. 2017;18(6):1063-1069.
Smith RJ, Kilaru AS, Perrone J, et al. How, why, and for whom do emergency medicine providers use prescription drug monitoring programs?. Pain Medicine. 2015;16(6):1122-1131.
Hildebran C, Leichtling G, Irvine JM, et al. Clinical Styles and Practice Policies: Influence on Communication with Patients Regarding Worrisome Prescription Drug Monitoring Program Data. Pain Medicine. 2016;17(11):2061-2066.
Allen B, Harocopos A, Chernick R. Substance Use Stigma, Primary Care, and the New York State Prescription Drug Monitoring Program. Behavioral Medicine. 2020;46(1):52-62.
Internet System for Tracking Over-Prescribing. New York State Pub. L. No. 3343–a. Prescription monitoring program registry. Effective August 27, 2013.
Prescription Drug Monitoring Center of Excellence. PDMP prescriber use mandates: Current status and experiences in selected states. Boston, MA: PDMP Center of Excellence, Brandeis University Heller School of Social Policy and Management; 2016.
Rasubala L, Pernapati L, Velasquez X, et al. Impact of a Mandatory Prescription Drug Monitoring Program on Prescription of Opioid Analgesics by Dentists. PLoS One. 2015;10(8):e0135957.
Guest GS, MacQueen KM, Namey EE. Applied Thematic Analysis. Thousand Oaks, CA: Sage Publications; 2011.
Berner ES, Graber ML. Overconfidence as a cause of diagnostic error in medicine. American Journal of Medicine. 2008;121(5 Suppl):S2-S23.
Meyer AN, Payne VL, Meeks DW, et al. Physicians' diagnostic accuracy, confidence, and resource requests: a vignette study. JAMA Internal Medicine. 2013;173(21):1952-1958.
Livingston JD, Milne T, Fang ML, et al. The effectiveness of interventions for reducing stigma related to substance use disorders: a systematic review. Addiction. 2012;107(1):39-50.
Tong S, Sabo R, Aycock R, et al. Assessment of Addiction Medicine Training in Family Medicine Residency Programs: A CERA Study. Family Medicine. 2017;49(7):537-543.
Friedman CP, Elstein AS, Wolf FM, et al. Enhancement of clinicians' diagnostic reasoning by computer-based consultation: a multisite study of 2 systems. JAMA. 1999;282(19):1851-1856.
Finley EP, Schneegans S, Tami C, et al. Implementing prescription drug monitoring and other clinical decision support for opioid risk mitigation in a military health care setting: a qualitative feasibility study. Journal of the American Medical Informatics Association. 2018;25(5):515-522.
Patel S, Carmichael JM, Taylor JM, et al. Evaluating the Impact of a Clinical Decision Support Tool to Reduce Chronic Opioid Dose and Decrease Risk Classification in a Veteran Population. Annals of Pharmacotherapy. 2018;52(4):325-331.
Price-Haywood EG, Robinson W, Harden-Barrios J, et al. Intelligent Clinical Decision Support to Improve Safe Opioid Management of Chronic Noncancer Pain in Primary Care. Ochsner Journal. 2018;18(1):30-35.
Kattan J, Fox AD, Cunningham CO, et al. Buprenorphine—An office-based treatment for opioid use disorder. City Health Information. 2015;34(1):1-8.
Cheng DR, Scodellaro T, Uahwatanasakul W, et al. An Electronic Medical Record in Pediatric Medical Education: Survey of Medical Students' Expectations and Experiences. Applied Clinical Informatics. 2018;9(4):809-816.
Keenan CR, Nguyen HH, Srinivasan M. Electronic medical records and their impact on resident and medical student education. Academic Psychiatry. 2006;30(6):522-527.
Barnett JS. Incorporating electronic medical records into the physician assistant educational curriculum. Journal of Physician Assistant Education. 2013;24(2):48-54.
Davis CS, Carr D. Physician continuing education to reduce opioid misuse, abuse, and overdose: Many opportunities, few requirements. Drug and Alcohol Dependence. 2016;163:100-107.
St Marie B, Broglio K. Managing Pain in the Setting of Opioid Use Disorder. Pain Management Nursing. 2020;21(1):26-34.
Elman I, Zubieta JK, Borsook D. The missing p in psychiatric training: why it is important to teach pain to psychiatrists. Archives of General Psychiatry. 2011;68(1):12-20.
Harsono D, Galletly CL, O'Keefe E, et al. Criminalization of HIV Exposure: A Review of Empirical Studies in the United States. AIDS and Behavior. 2017;21(1):27-50.
Association of Women’s Health, Obstetric, and Neonatal Nurses. Criminalization of pregnant women with substance use disorders. Nursing for Womens Health. 2015;19(1):93–95.
Knight KR. addicted.pregnant.poor. Durham, NC: Duke University Press; 2015.
Guba, EG. Criteria for assessing the trustworthiness of naturalistic inquiries. Educational Communication and Technology. 1981; 29(2):75-91.
The authors thank Dr. Denise Paone and Dr. Hillary Kunins for their thoughtful critiques of this manuscript, as well as the Primary Care Information Project of the New York City Department of Health and Mental Hygiene for its support of this study.
This research was supported by grant number 2014-PM-BX-0015, awarded by the Bureau of Justice Assistance, US Department of Justice.
Conflict of Interest
The authors declare no conflicts of interest. At the time the research was conducted, all authors were employed by the New York City Department of Health and Mental Hygiene.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Chernick, R., Allen, B. & Harocopos, A. Primary Care Implementation of a Mandatory Prescription Drug Monitoring Program in New York City. J Behav Health Serv Res (2021). https://doi.org/10.1007/s11414-021-09766-0