Prescription drug abuse - A question of balance

The current challenge facing physicians regarding the prescribing of controlled medications is to develop a new balance of prescribing. Faced with the clinical reality of underprescribing of narcotic analgesics and benzodiazepines to the majority of patients, and the overprescribing to the minority of patients who have histories of substance abuse and dependence, finding this new balance will be difficult. Strategies to help achieve a more therapeutic balance point include improved screening skills for chemical dependence, knowledge of the differential diagnosis and management of acute pain chronic pain anxiety and insomnia, careful charting behaviors, improved knowledge of controlled drug pharmacology, practice dealing with common seams, and increased comfort when saying ''no'' to patients who push for prescriptions.