Diversion of controlled substances from medical to nonmedical purposes is a significant public health problem. However, there is great fear that regulatory efforts to curb this activity could have a chilling effect on appropriate and necessary pain management.

To track the extent to which there is inappropriate prescribing and dispensing of controlled substances, seventeen states have adopted prescription monitoring programs. Although earlier programs relied on ink-on-paper multiple copy or serialized prescriptions, the recent trend has been the development of electronic-based programs that can link to computerized pharmacy systems. Although these programs have not been thoroughly analyzed for their safety or efficacy, there is growing enthusiasm for them. The Drug Enforcement Administration (DEA) backs the development of state-based electronic prescription monitoring programs and a bill is pending in Congress that would create a national program.