The rising frequency with which headlines announce celebrity and non-celebrity deaths due to prescription drug overdose has elevated public awareness that non-medical use, abuse, diversion, and morbidity associated with prescription narcotics have increased rapidly across the United States. Published data and events warn us that a great deal of opioid abuse, morbidity, and mortality stems directly from prescriptions written by clinicians who are innocently attempting to manage their patients' acute and chronic pain. Conversely, there is a flip side to the increasing attention given to the improper use of analgesic medications in that failure to provide adequate treatment for pain has been a widespread problem in medicine. So how do the caregivers, payers and coordinators of patient care find a balance between adequate pain management and misuse/abuse of prescription narcotics?

Claim database analyses reveal some startling findings that point to the fact that despite formulary restrictions, pre-authorization requirements, and various regulatory monitoring programs, there is significant room to reduce both patient risk and unnecessary health care costs due to opioid prescribing. This paper examines the issues and a number of techniques that payers can employ to help attain the fine balance of assisting patients with adequate pain management while simultaneously reducing adverse risks and the potential for chemical dependency.