Reading and Documenting PDMP Reports in Palliative and Hospice Care

Prescription Drug Monitoring Programs (PDMPs) are state-run electronic databases that track controlled substance prescribing and dispensing. While they were originally designed as a tool to combat the opioid epidemic, PDMPs are now an expected part of safe, compliant medical practice in nearly every setting—including palliative care and hospice. For providers who are managing symptoms in patients with advanced illness, these reports can sometimes feel like a bureaucratic hurdle. In reality, however, they serve as both a clinical tool and a medico-legal safeguard when approached thoughtfully.

Why PDMPs Matter in Palliative and Hospice Care

Patients in palliative care often require opioids, benzodiazepines, or other controlled substances for symptom management. The goals here differ from chronic pain clinics or primary care: we are aiming to maximize comfort, not necessarily to reduce long-term opioid exposure. Yet the legal and regulatory expectations remain the same.

PDMP review helps providers:

• Confirm prescribing accuracy – ensuring that the medications dispensed match what was intended.
• Identify poly-prescriber or poly-pharmacy concerns – sometimes patients receive controlled substances from multiple specialists (oncology, psychiatry, hospital discharge teams).
• Detect high-risk combinations – such as concurrent opioid and benzodiazepine use, which heightens overdose risk.
• Protect against diversion – particularly in patients with high caregiver burden or family conflict, where medications may be misused by others.

How to Read a PDMP Report

PDMPs vary by state, but the key elements are consistent:

1. Patient Verification
   Confirm that the demographics match. Multiple addresses, misspelled names, or different dates of birth can reveal duplicate records.
2. Medication Review
   Look closely at the controlled substances listed: name, strength, quantity, and formulation. Consider whether the prescription volume is consistent with palliative or hospice needs.
3. Prescriber Patterns
   Is your name the only prescriber? Are oncology, psychiatry, or hospitalists involved? Determine whether multiple prescribers represent coordinated care or a red flag for misuse.
4. Pharmacy Use
   One consistent pharmacy is reassuring; multiple pharmacies in a short period may suggest “pharmacy shopping” or fragmented care.
5. Timing of Fills
   Are medications being filled on time, too early, or overlapping? In palliative care, early refills may sometimes reflect acute escalations in symptoms—but documentation is key.
6. Combination Risks
   Pay attention to opioids plus benzodiazepines, stimulants, or gabapentinoids. While common in advanced illness, regulators view these combinations as risky without clear rationale.

Red Flags to Recognize

Even in palliative or hospice settings, the following patterns should prompt further exploration and documentation:

• Multiple prescribers without clear coordination.
• Early or repeated requests for refills.
• Discrepancies between reported use and dispensed quantities.
• High cumulative morphine milligram equivalents (MME) without explanation.
• Medications being filled far from the patient’s home.

Documentation: Protecting Your Patients and Yourself

From a compliance standpoint, it’s not enough to simply check the PDMP—you must document that you did so and explain how the findings influenced your prescribing decision. Regulators, payers, and medical boards increasingly look for this trail of clinical reasoning.

Best practices include:

• Always document the date of review (e.g., “PDMP reviewed on 9/12/2025”).
• Summarize findings clearly (“Findings consistent with my prescribing. No evidence of multiple prescribers or early refills.”).
• Explain red flags when present (“Opioid prescription also noted from oncology for cancer-related pain; coordinated with oncology team. No evidence of aberrant behavior.”).
• State your plan (continue regimen, coordinate with other prescriber, adjust therapy, initiate monitoring, etc.).
• Keep language factual, not judgmental—stick to the data and your clinical reasoning.

This documentation not only satisfies regulatory expectations but also strengthens interdisciplinary communication. Nurses, social workers, and pharmacists reviewing your note gain confidence that prescribing decisions are deliberate, transparent, and patient-centered.

A Practical Template

For everyday use, many providers benefit from a simple structure that can be adapted based on the case’s complexity:

• Date of Review: [Insert Date]
• Summary of Findings: [Brief description of prescriptions, prescribers, pharmacies, timing]
• Interpretation: [Consistent with care plan / additional prescriber involved / red flags identified]
• Action/Plan: [Continue regimen / coordinate care / adjust therapy / initiate monitoring]
• Provider Statement: “PDMP reviewed and considered in prescribing decision. Findings documented above.”

This template can be expanded into a more detailed narrative when red flags are present or reduced to a one-liner when the report is clean.

Clinical Nuances in Hospice and Palliative Care

It is important to remember that the regulatory lens often assumes long-term pain or behavioral health management scenarios, not end-of-life care. In hospice, patients may require escalating opioid doses, combinations of sedatives, or frequent refills that would normally raise concerns in other contexts. The critical safeguard is clear documentation of prognosis, goals of care, and clinical justification.

For example:
“PDMP reviewed 9/12/2025. Escalating opioid doses noted, consistent with advancing metastatic disease. Prescriptions from oncology confirmed and coordinated with hospice plan of care.”

Such statements highlight that the prescribing is not only appropriate but also necessary given the patient’s condition.
Conclusion

PDMP reports are not just regulatory hurdles—they are tools that can enhance safe prescribing and protect both patients and providers. In palliative and hospice care, where controlled substances are integral to compassionate symptom management, PDMP checks offer reassurance that prescribing is appropriate, coordinated, and transparent.

By learning to read PDMP reports systematically and documenting thoughtfully, hospice and palliative providers can ensure they meet compliance standards while staying true to the mission of providing comfort at the end of life.

References

Bohnert, A.S.B., Guy, G.P. & Losby, J.L., 2018. Opioid prescribing in the United States before and after the Centers for Disease Control and Prevention’s 2016 opioid guideline. Annals of Internal Medicine, 169(6), pp.367–375.

Dowell, D., Ragan, K.R., Jones, C.M., Baldwin, G.T., Chou, R. & CDC Opioid Workgroup, 2022. CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. MMWR Recommendations and Reports, 71(3), pp.1–95.

Frieden, T.R. & Houry, D., 2016. Reducing the risks of relief — The CDC opioid-prescribing guideline. New England Journal of Medicine, 374(16), pp.1501–1504.

Haffajee, R.L., Jena, A.B. & Weiner, S.G., 2015. Mandatory use of prescription drug monitoring programs. JAMA, 313(9), pp.891–892.

Manhapra, A., Arias, A.J. & Ballantyne, J.C., 2017. The conundrum of opioid tapering in long-term opioid therapy for chronic pain: A commentary. Substance Abuse, 38(1), pp.33–36.

Paulozzi, L.J., Kilbourne, E.M. & Desai, H.A., 2011. Prescription drug monitoring programs and death rates from drug overdose. Pain Medicine, 12(5), pp.747–754.

Starrels, J.L., Fox, A.D., Kunins, H.V. & Cunningham, C.O., 2012. They don’t know what they don’t know: Internal medicine residents’ knowledge and confidence in prescribing opioids for chronic pain. Journal of General Internal Medicine, 27(11), pp.1185–1191.

U.S. Department of Justice, Drug Enforcement Administration, 2020. Practitioner’s Manual: An Informational Outline of the Controlled Substances Act. DEA Office of Diversion Control.