The Commission recommends that PDMP enrollment mandates be universal in the USA and Canadian health care systems, with additional requirements to check the system when initiating patients onto controlled substances such as opioids. Prescribers should be compensated for the costs of PMDP participation and to make the process easier, technical improvements in PDMPs should be a high priority. These include integrating PDMPs into or linking them with widely used electronic medical record systems. For electronic prescribing, the ideal system would automatically conduct the PDMP check, alert the prescriber and pharmacist of any suspected doctor shopping or potentially dangerous drug interactions, and then upload the patient data to the PDMP database if the prescription were approved. PDMPs should also build on the recent trend (e.g., in the U.S. Department of Veterans Affairs PMDP) of sharing data across states and provinces. Further, PDMPs should include dispensing from methadone maintenance clinics and “medical cannabis” dispensaries in order to create a more complete list of controlled substances. 

     “Nudges” within electronic prescribing systems also merit expansion. Implementing nudges at scale within electronic prescribing systems is a low-cost, minimally intrusive method to promote judicious prescribing.