The Challenge of Prescription Drug Misuse: A Review and Commentary

This article presents an analysis of the patterns of illicit use of prescription pain relievers, of the likely structure of the illicit market, and of the complexity of pain management. It suggests that a federal enforcement policy focused on physicians is unlikely to reduce the overall use of illicit drugs, but that it is likely to have an adverse impact on the ethical structure of medical care and to compromise the effectiveness of pain treatment. Pain medications, such as OxyContin, Vicodin, and Methadone, have received increased government and media attention over the last 2 or 3 years, as the growth of their application in the treatment of patients with acute and chronic pain has been accompanied by an increase in reported drug abuse and dependence, adverse medical events, and pharmacy robberies. In response, the federal government announced a new initiative to control prescription drug abuse.1 Various proposed measures, including heightened scrutiny of physicians' practices, increased prosecution of physicians, increased restrictions on a number of pain medications, drug monitoring programs to catch “doctor shoppers,” and encouragement of more rigorous patient screening, will, it is claimed, limit the diversion of prescription medications from medical channels.