title: Physician attitudes and experiences with Maryland's prescription drug monitoring program (PDMP).
abstract: Physicians' use of prescription drug monitoring programs (PDMPs) varies by state. Among Maryland physicians, we sought to (1) estimate the PDMP impact on changes in opioid prescribing, (2) approximate the scope of PDMP utility and (3) determine the barriers to PDMP use after its 2013 implementation.
  
  
  
  Cross-sectional postal survey linking responses to state records of PDMP registration and use, randomly sampling physicians within specialty and registration strata.
  
  
  
  Maryland, USA.
  
  
  
  A total of 1000 surveyed primary care, pain and emergency medicine physicians stratified into three subpopulations: PDMP non-registrants, PDMP registrants who were non-users and PDMP users; 405 respondents (44%) of 916 eligible physicians were analysed.
  
  
  
  Primary outcome measure was PDMP use. Key predictors were clinic characteristics, including type of practice and number of patients prescribed opioids.
  
  
  
  No response-wave bias was identified. Seventy per cent of physicians believed PDMP access decreased their amount and increased their comfort level in prescribing opioids. Three-fourths (74%) of PDMP users reported the data very useful for informing opioid prescribing, although one-fifth (20%) reported difficulty accessing the data. Commonly reported barriers to PDMP use were lack of knowledge regarding its existence and registration process. In multivariable analysis after adjusting for key clinic characteristics, practicing at a managed care organization was associated with lower PDMP use [incidence rate ratio (IRR) = 0.19, 95% confidence interval (CI) = 0.05-0.73]. Conversely, physicians who prescribed opioids for more than 50 patients accessed the PDMP three times as often as those prescribing opioids for fewer than 10 patients monthly (IRR = 3.00, 95 % CI = 1.07-8.43).
  
  
  
  In this survey of Maryland, USA physicians, most participants reported that prescription drug monitoring programs (PDMPs) improved their opioid prescribing by decreasing prescription amounts and increasing comfort with prescribing opioids. Common barriers to PDMP use included not knowing about the program, registration difficulties and data access difficulties.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.|Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Dora H
authors.initials: DH
authors.lastname: Lin
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.|Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Lucas
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.|Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Irene B
authors.initials: IB
authors.lastname: Murimi
authors.affiliation: Behavioral Health Administration, Maryland Department of Health and Mental Hygiene, Catonsville, MD, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Jackson
authors.affiliation: Behavioral Health Administration, Maryland Department of Health and Mental Hygiene, Catonsville, MD, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Baier
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Shannon
authors.initials: S
authors.lastname: Frattaroli
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.|Center for Injury Research and Policy, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Gielen
authors.affiliation: Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, MD, USA.
authors.forename: Patience
authors.initials: P
authors.lastname: Moyo
authors.affiliation: Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, MD, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Simoni-Wastila
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.|Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA.|Division of General Internal Medicine, Department of Medicine, Johns Hopkins Medicine, Baltimore, MD, USA.
authors.forename: G Caleb
authors.initials: GC
authors.lastname: Alexander
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008396:Maryland; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000517:prevention & control*; D010820:Physicians / Q000523:psychology*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D063487:Prescription Drug Misuse / Q000517:prevention & control*; D000073958:Prescription Drug Monitoring Programs / Q000706:statistics & numerical data*
keywords: Controlled substance monitoring; Prescription Drug Monitoring Programs; doctor shopping; drug utilization; policy; prescription drug abuse; prescription opioid epidemic; prescription opioids; substance use disorder