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Prescription Drug Abuse

TO THE EDITOR: It is disappointing that Kirschner and colleagues' (1) position paper on prescription drug abuse focuses almost exclusively on the supply end of the problem while ignoring demandspecifically, demand by those who are today dependent on prescription painkillers. In fact, the word dependence appears in only 1 paragraph of this lengthy paper and within a section subtitled Drug Enforcement Administration. Surely physicians, more than any other segment of society, should be keenly aware that drug dependence is a chronic medical condition that in most cases requires treatment. Without treatment, successful efforts to curtail supply actually exacerbate the dangers to the patient and society. As availability of prescription painkillers decreases and price increases, many who are dependent will turn to misuse of heroin; precisely such a change has been widely reported in the past few years. The explanation for the distressing and unexpected failure of the American College of Physicians to emphasize first and foremost the need for treatment seems to lie in its focus on abuse rather than on medical and social consequences. Drug abuse is not a clinical diagnosis! I respectfully urge that, in addition to providing guidance on appropriate prescribing of potentially harmful medications, the College advocate strenuously for ready access to treatment of dependence for those who want it, need it, and may well die without it.