An increase in the prescribing of opioids in an effort to improve management of chronic pain has led to enhanced availability of controlled substances for diversion and abuse. Evidence suggests that the use of prescription monitoring programs (PMPs) may help curtail this growing public health issue. The current use of PMPs varies widely from state to state but there have been important changes improving interconnectivity of PMPs across states. This paper describes current data on the effect of prescription monitoring programs on reducing abuse and diversion of controlled substances. It also offers suggestions on how PMPs may be incorporated into practice and clinical decision-making to ensure appropriate pain management and patient safety.