Table 2. Domains, Themes, Representative Interview Quotes, and Research Hypotheses from Emergency Department (ED) physicians regarding Prescription Dug Monitoring Programs (PDMPs).

Domain	Theme	Representative Quotation	Research questions
Barriers and Facilitators to PDMP Use	Awareness	“I have read a few academic papers that have discussed about the decreasing in opiate prescription abuse and abuse of the system with these monitoring programs. But, I know there's a number of legal issues to get through and not all states have them as of yet”	Looking ahead, how do we support the development of nation-wide PDMPs?
	Access and Time	“Yeah, I mean, it takes time to log-in, whatever time it takes to log-in and do this, in an busy ER, if you're the attending and there are four residents that are presenting cases to you and you're seeing patients on your own, I mean, that could be a little bit – it'd be nice if there was somebody else who could do it for me, like a clerk or something like that could run the report for me.”	Does expanding PDMP* access to resident physicians and mid-level providers improve e patient care, PDMP use and work flow in the ED increase use and improve care?
How Physicians Use PDMPs	Frequency	“Whether I check our state's prescription monitoring program, pretty much on every single patient with pain at this point because there's – it's crazy what it reveals.”	Does frequency of use quantitatively predict or change a provider's opioid prescribing patterns?
	Patient Factors and Clinical Impressions	“when it goes off in the back of your head and you're like is this somebody who's got an opioid problem and I'm just going to be feeding it? So you go and you look them up and what's interesting in my gestalt is that I'm often wrong. I'm just convinced this person is playing me. I go look him up. Absolutely nothing in the database and okay, I was wrong and I was really glad that I treated them nicely the whole time, you know.” “I feel like it gets used most when there's a higher suspicion that there is misuse or abuse of the drugs. “ “Or, if I think that their story is somehow not uniform, if there's any discontinuity in the story. And, the discontinuity, that's what is really subjective. I don't have a digital way of doing that. Pain, out of portion of findings – then I will look, access.”	What are best management practices? How and when should PDMPs* be accessed? What are the guidelines for who should be screened with the PDMP*?
Alternative PDMP Use	PDMP for provider-patient education	“I'll actually go in and say I understand you're having pain. I am more than happy to give you something other than Percocet or write a prescription for something that is not a narcotic, but I am concerned. Did you realize that in the last 5 months you have had 540 Percocet's prescribed to you? I've had several people go I have? They didn't realize that they were actually taking that much pain medicine. Then I try to open up a conversation of you can become addicted to these pain medicines. Your body can become dependent on them just like a heroin addict and it really – some people are like well I don't wanna be on these medicines forever and it gives them kind of an eye opening” “it's very helpful in having the discussion of, I'm not going to prescribe you any opioids or narcotics at this time because of this and actually I think patient response is – it's kind of like, you caught me, sort of thing, or you know – so, I think it makes it easier and it avoids a little bit of argument because there's hard evidence that you're abusing the system” “At the same time, the one that you print out the four pages of narcotics filled in this last year, I just I use that as a teaching tool” “There are a few patients that have actually admitted that they have an addict problem and I've gotten them addiction resources and gotten a social worker to come talk with them and that sort of thing.”	Do PDMPs create a space for improving communication, education, and understanding of the risks of opioids? Does PDMP usage by providers improve provider empathy? Does PDMP use by providers lead to improved strategies of pain management outcomes among patients?
	Novel utility/Connecting with patients	“We're trying to make it less punitive, we don't really want it to be punitive because it's almost like a psychiatric problem or something like that and so we try to explain that, but we use it frequently.” “But, I use it for a lot of other things. Things like, trying to see how many providers they have. Talking to the patients. I often bring it to the patient to try and get to the bottom of what's going on, why they're in the emergency department that day for their chronic condition, why we can't get them adequate follow-up, what's going on with that follow-up. I use it for medication interactions, to make sure that they're not on medications that put them at higher risk for morbidity or mortality in the long run.	Does PDMP use decrease ED visits by patients seeking opioids? What are patient perspectives on PDMP usage?