The United States continues to struggle to find effective and enduring strategies when approaching the opioid crisis. One significant area of concern is the diversion of opioids from legitimate medical practice. Criminal diversion can be extremely difficult to detect with standard patient assessment tools of a clinical history, examination, medical records review, and urine drug testing. "Doctor shopping" where an individual seeks opioids from multiple prescribers to either use themselves or divert represents profound safety concerns. A prescriber may be better positioned to assess their patients with an accurate understanding of dispensing records. Although many states have had operational programs to monitor dispensed prescription opioids for decades, historically the design of these programs was to monitor the prescribers, not patients. Over the last two decades, prescription drug monitoring programs (PDMPs) have been somewhat repurposed and are now featured as one of the primary tools healthcare professionals can implement to combat inappropriate prescribing. Prescription drug monitoring databases have received strong support and not only does nearly every opioid guideline support them, in some jurisdictions it has become a legal requirement. Despite the increased use of this data in clinical practice, governmental survey results continue to identify diversion as a primary source of prescribable opioids that are misused. In an effort to enhance patient safety, a deeper understanding of the benefits and limitations of prescription drug monitoring data is needed. This session will highlight the history of these programs, the evidence pertaining to their benefits and risks, as well as case studies and clinical pearls from the front line.