It may often seem that doctors don’t trust their patients regarding management of their medications, particularly controlled substances, including tranquilizers and stimulants. This is a dilemma that I face all the time in my practice. Some medications are powerful and excellent at treating specific symptoms, such as Xanax for anxiety, but they carry significant risk of dependency and misuse as recreational drugs.

I am a strong believer in using the right medication and not being fearful of using these medications when they are indicated, as long my patient and I engage in ongoing conversations about the risks and that we both carefully monitor their usage.

It is not that I don’t trust the patient so much as I know that brains can develop attachments to these medications regardless of the patient’s best intentions. As doctors, we must balance the need to use the appropriate medicine (in high enough doses and in enough supply) for the patient to get symptom relief with the true medical risks associated with these meds.

The same dilemma arises with narcotic pain medications in other specialties. We need to use enough to provide relief and not be afraid of using those medicines because of the concern about addiction in our patients. But we can’t ignore risks of any medicine, and we must put strategies into place to reduce those risks; careful monitoring and effective communication are ways we can do that.

Patients with long histories of regular use of various medications are often going to have more flexibility in dosing and supply, but I am still going to follow their use, in alliance with them, to make sure that their brain isn’t becoming dependent or that their needs aren’t increasing significantly without understanding what is going on with their symptoms.

Please share your experiences, insights, and opinions. Do you think doctors, as a general rule, are overly restrictive in giving patients access to medications or not restrictive enough? If a person has a good track record of knowing what she or he needs and not abusing the privilege, should that individual have more control over her or his own medication management? Have you ever had a doctor refuse to prescribe a medication you were convinced could help you? If so, what, if anything, did you do about it?

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PsychCentral (August 17, 2010)

    Last reviewed: 17 Aug 2010