The street life of drugs
CMAJ 1999;160;27
In response to: M. Latowsky; J.F. Anderson
Dr. Latowsky is correct when he links the abuse of prescription and illicit drugs, and he is right to frame the problem of drug abuse in the wider social and psychological context. Although decriminalization is an issue best left to public discourse, there is no doubt that the simple application of laws and regulations cannot and will not solve the problem of drug abuse.
Dr. Anderson's observations do not challenge the premise that his study amply demonstrated. Mere notification of prescribers whose prescribing practices were more than 2 standard deviations above the mean was sufficient to result in a 25% drop in the prescribing of opioid analgesics. This kind of observation has been replicated in many US jurisdictions with multiple-copy prescription programs.14 Although Anderson is rightly concerned about the prescribing of propoxyphene in the cohort of physicians notified, it would have been far more effective to have told the physicians prescribing it that the drug is of limited proven value in treating chronic pain. Of greater concern is the lack of data on the effect of decreased prescribing of opioid analgesics. In the absence of such data, it is impossible to say whether such notification helped or harmed the physicians' patients.
Brian Goldman, MD
Toronto, Ont.
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References
- Hill CS. Influence of regulatory agencies on the treatment of pain and standards of medical practice for the use of narcotics. Pain Digest 1991;1:7-12.
- Zenz M, Sorge J. Is the therapeutic use of opioids adversely affected by prejudice and law? Recent Results Cancer Res 1991;121:43-50.
- Clark HW, Sees KL. Opioids, chronic pain and the law. J Pain Symptom Manage 1993;8:297-305.
- Weintraub M, Singh S, Byrne L, et al. Consequences of the 1989 New York State triplicate benzodiazepine prescription regulations. JAMA 1991;266:2392-7.
