Capsule Commentary on Radomski et al.’s Physicians’ Perspectives
Regarding Prescription Drug Monitoring Program Use
Within the Department of Veterans Affairs: a Multi-state Qualitative
Mark W. Vander Weg, Ph.D.
Iowa City VA Health Care System, Iowa City, IA, USA;
Department of Internal Medicine, University of Iowa, Iowa City, IA, USA;
Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA.
J Gen Intern Med 33(8):1381
© Society of General Internal Medicine (This is a U.S. Government work
and not under copyright protection in the US; foreign copyright protection
may apply) 2018
lthough progress has been made in reducing the amount
of opioids prescribed in the USA, their use remains
widespread. To effectively address the morbidity and mortality
associated with these medications, fundamental changes to the
way that we approach their use are needed.
One approach receiving increased attention is the use of
Prescription Drug Monitoring Programs (PDMPs).
PDMPs are statewide databases that track the prescribing
and dispensing of controlled substances and that are de-
signed to help prescribers and other stakeholders identify
and prevent their misuse. Although evaluations of their
impact have yielded mixed results, accumulating evidence
suggests that state PDMPs with robust features including
strong mandates regarding registration and use are associ-
ated with reductions in opioid prescribing
Unfortunately, PDMPs remain greatly underutilized,
substantially undermines their potential impact. To help un-
derstand why, Radomski et al.
investigated the Department of
Veterans Affairs (VA) physicians’ perspectives regarding
PDMPs. Primary care providers from states with differing
levels of prescriber access to PDMPs were interviewed regard-
ing their experiences with PDMPs as well as barriers and
facilitators to their use. Although support for PDMPs was
widespread, difficulties accessing key information and signif-
icant administrative burdens were noted. Limited availability
of VA prescription data in state PDMPs was also viewed as
problematic. Linking PDMPs to the electronic medical record
(EMR), access to note templates to facilitate documentation,
and the ability to delegate routine queries to ancillary staff
were identified as desired modifications to enhance usability.
Radomski et al.’s
rigorous qualitative approach allowed for
a greater understanding of factors influencing prescribers
PDMP use. Their findings are consistent with prior work
suggesting that access difficulties are prominent barriers to
Although linking PDMPs to the EMR may raise
concerns about information security, it is encouraging that the
proposed solutions are feasible and apply to both VA and non-
When designed correctly and used consistently, PDMPs
hold considerable promise for improving prescribing practices
and reducing patient risk. If PDMPs are to fulfill their full
potential, steps to facilitate their use such as those identified by
Radomski et al.
Corresponding Author: Mark W. Vander Weg, Ph.D.; Iowa City VA
Health Care System, Iowa City, IA, USA (e-mail: mark-
Compliance with ethical standards:
Conflict of interest: The author declares that he has no conflict of
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Published online June 4, 2018