PDMP (Prescription Drug Monitoring Program): You Are Legally Required to Check the Database, But When? The State-by-State Rules You Must Know.

PDMP (Prescription Drug Monitoring Program): You Are Legally Required to Check the Database, But When? The State-by-State Rules You Must Know.

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Most states now require clinicians to check their Prescription Drug Monitoring Program (PDMP) before writing certain controlled-substance prescriptions. The goal is to spot risky combinations, doctor shopping, and high doses before harm happens. The catch: the exact “when” varies by state, drug class, and clinical setting. Below is a practical guide to the common rules, why they exist, and a state-by-state snapshot so you can build a workflow that stays compliant and protects patients.

What PDMP laws usually require (and why)

States write PDMP mandates to prevent overdoses and diversion without blocking needed care. So most laws focus on opioids and benzodiazepines, first-time prescribing, and ongoing long-term therapy. That is where risk is highest and a quick database check adds the most value.

  • First-time prescription checks: Many states require a PDMP query the first time you prescribe an opioid or benzodiazepine to a patient. This prevents missing a high baseline risk.
  • Ongoing therapy checks: For chronic use, states often require re-checks at set intervals (commonly every 90 days). Risks change over time, so the law forces periodic review.
  • Scope by drug: Some states require checking for all Schedules II–V; others limit mandates to opioids/benzodiazepines or specific drugs (for example, carisoprodol in Texas).
  • Exemptions: Typical exemptions include hospice, inpatient care, emergencies, short acute supplies (often 3–7 days), or when the PDMP is down. These carve-outs balance safety with clinical realities.
  • Delegates: Most states let trained staff run PDMP queries for a prescriber. This is how clinics keep pace without slowing patient flow.

How to stay compliant without slowing care

  • Decide triggers by policy: Make it automatic to check the PDMP a) before the first opioid/benzodiazepine script, and b) at least every 90 days if therapy continues. This meets or exceeds most state rules.
  • Use delegates: Authorize MAs, RNs, or pharmacists as allowed. Have them run the PDMP before the visit so you can act on the results.
  • Document the check: Note the date, who checked (delegate vs prescriber), and any action taken (e.g., adjusted dose, avoided duplication). If an exemption applies, document why.
  • Build EHR prompts: Set alerts for new opioid/benzo starts and 90-day chronic care intervals.
  • Plan for downtime: Keep a short, pre-approved script template and a note macro for “PDMP unavailable” scenarios that your state recognizes.

State-by-state rules you should know

Important: Laws change often and boards issue detailed guidance. Use the summaries below as practical direction, then confirm specifics with your state board or PDMP program. Where timing (e.g., “every 90 days”) varies by state, follow your state’s exact interval if it is stricter.

  • Alabama: PDMP check generally required before initial opioid/benzodiazepine prescribing and periodically for ongoing therapy. Typical exemptions: hospice, inpatient, emergencies.
  • Alaska: Check for initial opioid therapy (and often benzodiazepines) and at intervals for chronic treatment.
  • Arizona: Query before first opioid or benzodiazepine; re-check about every 3 months while continuing.
  • Arkansas: Check before starting opioids/benzodiazepines and at least every 90 days if continued.
  • California (CURES): Must check before first prescribing a Schedule II–IV controlled substance to a patient and at least every 4 months if it remains in the plan. Common exemptions: hospice, certain short ED or post-op supplies, inpatient.
  • Colorado: Check for opioids before the second fill or when exceeding short acute limits; benzodiazepine checks are required for ongoing therapy. Use PDMP for dose escalations and combinations.
  • Connecticut: Check before prescribing a controlled substance exceeding a brief (e.g., 72-hour) supply; re-check every 90 days for chronic use.
  • Delaware: PDMP check before first opioid/benzodiazepine prescription and periodically thereafter (often at least every 6 months).
  • District of Columbia: Check when prescribing opioids/benzodiazepines beyond a short acute course (e.g., >7 days), and at intervals (about every 90 days) for chronic therapy.
  • Florida: Generally requires a PDMP consult before prescribing or dispensing controlled substances to most outpatients; typical exemptions include hospice, inpatient, emergencies.
  • Georgia: PDMP check before initial opioid/benzodiazepine prescription and at least every 90 days if continuing.
  • Hawaii: Check for first-time opioid/benzodiazepine prescribing and periodically for chronic use.
  • Idaho: Query before initial opioid/benzodiazepine prescribing; periodic re-checks (often at least annually) for chronic therapy.
  • Illinois: Check the PDMP before prescribing opioids; many prescribers also must check for benzodiazepines and stimulants. Re-check periodically (commonly every 90 days).
  • Indiana: PDMP check required before initial opioids/benzodiazepines and at intervals for ongoing treatment (often 90 days).
  • Iowa: Check before first opioid/benzodiazepine script and every 90 days if continuing.
  • Kansas: PDMP is active; statewide mandatory query rules are limited. Follow board or health-system policy and best practice to check for opioids/benzodiazepines.
  • Kentucky: Strong PDMP use requirements. Check prior to prescribing Schedule II and many high-risk III/IV drugs (including benzodiazepines) and regularly (often at least every 3 months).
  • Louisiana: Check before initial opioid/benzodiazepine prescribing and at least every 90 days if ongoing.
  • Maine: PDMP check before prescribing opioids/benzodiazepines and periodically (often 90 days).
  • Maryland: Check for initial opioid/benzodiazepine prescribing and re-check during chronic therapy (about every 90 days).
  • Massachusetts: Check before prescribing Schedule II or III opioids and before benzodiazepines; re-check at intervals (commonly 90 days) for ongoing therapy.
  • Michigan: Check PDMP before prescribing Schedule II–V controlled substances beyond a brief supply; re-check periodically for continued therapy.
  • Minnesota: Check before the first opioid prescription for acute pain and for chronic opioid therapy at intervals (often every 90 days). Benzodiazepine checks are increasingly expected for long-term use.
  • Mississippi: Check before initial opioid/benzodiazepine prescribing and at least every 3 months if continued.
  • Missouri: Statewide PDMP is live; statutory use mandate is limited. Many boards/health systems require checks for opioids/benzodiazepines—follow your board’s rule.
  • Montana: PDMP check for initial opioid/benzodiazepine prescribing and periodic re-checks for chronic therapy.
  • Nebraska: The PDMP captures nearly all prescriptions. A universal query mandate is limited; follow board and system policy, and check for opioids/benzodiazepines as standard practice.
  • Nevada: Check before first opioid prescription and at least every 90 days for ongoing opioid therapy; heightened documentation and MME rules apply.
  • New Hampshire: Check before first opioid/benzodiazepine or other targeted Schedule II–IV prescription and periodically thereafter.
  • New Jersey: PDMP check before initial opioid/benzodiazepine and at least every 3 months for ongoing therapy.
  • New Mexico: Check before starting opioids/benzodiazepines and every 3 months for chronic use.
  • New York (I-STOP): Check the PDMP before prescribing Schedules II–IV (effectively every time). Common exemptions: veterinarians, inpatient, hospice, emergencies.
  • North Carolina: “Targeted controlled substances” (Schedule II and III opioids) require PDMP checks at initiation and at least every 90 days if continued. Many clinicians also check for benzodiazepines.
  • North Dakota: Check for initial opioid/benzodiazepine prescriptions and re-check periodically for chronic therapy.
  • Ohio: Check before first opioid/benzodiazepine prescription and at least every 90 days if continued; use PDMP for risk signals and combinations.
  • Oklahoma: Check for opioids, benzodiazepines, and carisoprodol before prescribing and at least every 180 days if therapy continues.
  • Oregon: PDMP registration and use are strongly encouraged and required in defined situations by boards; best practice is to check for initial and chronic opioid/benzodiazepine therapy.
  • Pennsylvania: Check for first-time opioid/benzodiazepine prescribing and thereafter when continuing therapy or risk is present; many clinicians re-check at 90-day intervals.
  • Rhode Island: PDMP check before first opioid/benzodiazepine prescription and at least annually for ongoing therapy (more often if risk increases).
  • South Carolina: Check before initial opioid/benzodiazepine prescribing and at intervals (often every 90 days) during chronic use.
  • South Dakota: PDMP use requirements are more limited; follow board guidance and standard practice to check for opioids/benzodiazepines, especially for chronic therapy.
  • Tennessee: Check when starting opioids/benzodiazepines beyond brief acute use and at intervals (often every 6 months) for continued therapy.
  • Texas: Must check PDMP before prescribing opioids, benzodiazepines, barbiturates, or carisoprodol. Exemptions include hospice, cancer care, inpatient settings.
  • Utah: Check before starting opioids/benzodiazepines and at least every 3 months for chronic therapy.
  • Vermont: Check before first opioid prescription and again if treatment extends or exceeds acute limits (e.g., 90 days).
  • Virginia: Check when initiating opioids beyond short acute use and at least every 90 days while continuing; use PDMP for benzodiazepine co-prescribing decisions.
  • Washington: Mandatory PDMP checks for opioids and benzodiazepines at initiation and periodically (about every 3 months) for chronic therapy; additional checks for dose increases and co-prescribing.
  • West Virginia: Check before initial opioid/benzodiazepine prescribing and re-check at defined intervals (at least annually; more often for higher risk).
  • Wisconsin: Review the PDMP before issuing a controlled substance prescription and periodically (often every 90 days) during ongoing therapy.
  • Wyoming: PDMP checks for initial opioid/benzodiazepine prescribing and periodic re-checks are expected, particularly for chronic treatment.

Common exemptions and how to document them

  • Hospice or palliative care: Usually exempt. Document the status clearly.
  • Inpatient, ED, or SNF with administration on-site: Often exempt because meds are not dispensed for outpatient use.
  • Short acute supplies: Many states exempt 3–7 day non-refillable supplies. Note the duration and reason (e.g., post-op).
  • System downtime: Most states allow an exemption if the PDMP is unavailable. Record the outage and proceed with the minimum necessary supply.
  • Veterinary: Frequently exempt from human PDMP-use rules.

What to write in the note

  • “PDMP checked” + date/time + who checked: If a delegate checked, include their name.
  • Summary of findings: “No other opioid prescribers,” “Early fill 2 weeks ago,” or “Concurrent clonazepam.”
  • Action taken: Dose reduced, naloxone offered, taper planned, or decision to withhold prescription.
  • Exemption used (if any): “ED discharge, 3-day non-refillable supply,” or “CURES unavailable; limited 2-day supply.”

Bottom line

If you default to checking the PDMP before the first opioid or benzodiazepine prescription and at least every 90 days while continuing therapy, you will meet or exceed most state rules. Build it into your workflow with delegates and EHR prompts, and document your reasoning. Then confirm your state’s exact triggers and intervals—some are stricter (New York checks essentially every time; California requires a 4‑month recheck; Texas targets specific drug classes). The extra minute at the point of care prevents missed risks and keeps you squarely inside the law.

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