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Does the U.S. "war on drugs" impede prescribing of drugs for medical purposes? Have efforts to curtail abuse of prescription drugs been successful? Have these same efforts adversely affected patient care?

These tough questions were addressed at a recent (December 12-14, 1988, American Medical Association Symposium on Medicine and Public Policy held in the nation's capital. The symposium was titled "Balancing the response to prescription drug abuse."

The meeting was a follow-up to the 1980 White House Conference on Prescription Drug Misuse, Abuse and Diversion and followed closely on the heels of meetings with similar themes, including the Second International Congress on Cancer Pain, and a National Conference in Texas on the "Drug Treatment of Cancer Pain in a Drug Oriented Society: Adequate or Inadequate?" There have been increasing concerns in the medical community that proliferation of state anti-drug abuse laws and regulations may further discourage prescribing of drugs that are essential to the health and well-being of a number of patient groups, including cancer patients with pain. In his keynote address, Dr. Otis Bowen, former Secretary of the U.S. Department of Health and Human Services acknowledged the difficulty inherent in fighting a "war on drugs" while recognizing "the need to make sure therapeutic drugs are available to those who need them."

Papers were presented on the relative effectiveness and costs of several types of anti-prescription abuse programs. The most hotly debated issue was the increasing number of "multiple copy prescription programs" in various states and recent expansion of the triplicate prescription program in the state of New York to include the benzodiazepines. Triplicate advocate John L. Eadie of the New York Department of Health presented data on his program's effectiveness and indicated that patient care would not be compromised. Patient care advocate Ira J. Brody of the Epilepsy Institute said such programs "will not stop one addict from being an addict, but will reduce access by patients with legitimate medical needs."

In his closing address, Eric Sterling, Counsel to the U. S. House of Representatives Subcommittee on Crime, delivered remarks from Chairman William Hughes of New Jersey. Congressman Hughes has been a vigorous supporter of the "war on drugs" and was a cosponsor of legislation proposed in 1984 to make heroin available to dying cancer patients. He said the bill had been decisively defeated, "but it had an important positive effect on focusing attention on the need for a comprehensive effort to relieve cancer pain." He commended the Wisconsin Cancer Pain Initiative as "a project that ought to be replicated around the country and around the world." To the regulators in the audience he said, "when you see instances of heavy analgesia, be sensitive to the need for pain relief and the need for physicians to feel they can treat their patients' pain without fear of accusation."

The conference succeeded in making "balance" a national drug policy issue, and even if it did not achieve consensus on how this should be done, an important dialogue has begun.

David E. Joranson, MSSW, is Associate Director for Policy Studies, Pain Research Group, UW-Madison.