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. 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 2 decades, prescription drug monitoring programs (PDMPs) have been somewhat repurposed and are now featured as one of the primary tools for healthcare professionals to combat inappropriate prescribing. PDMPs have received strong support and, not only does nearly every opioid guideline support them, in some jurisdictions it has become a legal requirement. 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.