Commentary in response to Paulozzi et al. : prescription drug abuse and safe pain management

The study by Paulozzi, Budnitz, and Xi highlights the alarming problem of prescription drug abuse in America. These data have profound and disturbing ramifications. But if we are to have responsible and effective responses to prescription drug abuse, the problem must be considered in its full context. Solutions must factor in the full complexity of drug abuse, addiction and all of the related social and medical disorders, to avoid penalizing those with legitimate needs. In particular, we must be careful with implications that these data inadvertently suggest that prescription drug abuse is mostly related to prescribers and their patients, implying that limiting medically appropriate use will have any affect on reversing this disturbing trend. Just as in this report, many government statements and policies have simplistically assumed that the growing prescription drug abuse problem must rest largely with prescribers. As detailed in the accompanying commentary by Joranson and Gilson, this may be faulty logic based on inadequate data. Like prescription drug abuse, under-treated pain is also a public health crisis. A recent ABC News/USA Today/Stanford University poll estimated that approximately one of two Americans suffers from pain at any time and one in four has chronic pain.