Parametric decay instabilities (PDI) appear to be an ubiquitous feature of lower hybrid current drive (LHCD) experiments at high density. In density ramp experiments in Alcator C-Mod and other machines the onset of PDI activity has been well correlated with a decrease in current drive efficiency and production of fast electron bremsstrahlung. However whether PDI is the primary cause of the 'density limit', and if so by exactly what mechanism (beyond the obvious one of pump depletion) has not been clearly established. In order to further understand the connection, the frequency spectrum of PDI activity occurring during Alcator C-Mod LHCD experiments has been explored in detail by means of a number of RF probes distributed around the periphery of the C-Mod tokamak including a probe imbedded in the inner wall. The results show that (i) the excited spectra consists mainly of a few discrete ion cyclotron (IC) quasi-modes, which have higher growth than the ion sound branch; (ii) PDI activity can begin either at the inner or outer wall, depending on magnetic configuration; (iii) the frequencies of the IC quasi-modes correspond to the magnetic field strength close to the low-field side (LFS) or high-field side separatrix; and (iv) although PDI activity may initiate near the inner separatrix, the loss in fast electron bremsstrahlung is best correlated with the appearance of IC quasi-modes characteristic of the magnetic field strength near the LFS separatrix. These data, supported by growth rate calculations, point to the importance of the LFS scrape-off layer (SOL) density in determining PDI onset and degradation in current drive efficiency. By minimizing the SOL density it is possible to extend the core density regime over which PDI can be avoided, thus potentially maximizing the effectiveness of LHCD at high density. Increased current drive efficiency at high density has been achieved in FTU and EAST through lithium coating and special fuelling methods, and in recent C-Mod experiments by operating at higher plasma current. Another approach would be to locate the launcher in the inner wall with double null operation. This would reduce the SOL density by an order of magnitude or more and greatly mitigate the effects of PDI as well as other parasitic losses.