Prescription drug abuse: some considerations in evaluating policy responses

Although psychotherapeutics are among the most tightly regulated commodities in the world, some small but significant number are regularly diverted from legitimate use for the purpose of sustaining abuse and dependence. Contemporary concerns about such diversion have prompted renewed interest in methods to curb physicians' prescriptive authority and monitor actual prescribing practices. In order to manage these proposed solutions in a rational way, all interested parties need to become involved in decisions about system design and oversight. Practitioners (physicians, pharmacists, and other health professionals) should have input into decisions regarding program structure and exception criteria. Patients must insist on appropriate safeguards of their legitimate interests in maintaining personal privacy and access to medical care. Policymakers need to accurately assess (1) the nature and severity of the diversion problem to be addressed, (2) the resources to be allocated to the system, as well as the effect of such an allocation on the state's ability to meet other service needs, and (3) the "social algebra" of the system--that is, the extent to which the system, will foster undermedication of some patients as the cost of reducing overmedication of others.