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It's amazing how one little word can change the meaning of a sentence that yearns to mean something else. The new prescribing regulations from the Drug Enforcement Administration (DEA) covering Schedule II drugs contains just such a word: "undue." It states that physicians should "not create an undue risk of diversion or abuse of the medication" they prescribe. Since Schedule II drugs include opiates like OxyContin and Vicodin, such a risk could obviously lead to addictions and drug rehab, not to mention injury or death.

My three questions about the word "undue" are these:

1. Is there an appropriate, proper or justified risk of diversion or abuse?

2. If so, what parameters or conditions constitute such an appropriate, proper or justified risk of diversion or abuse? In other words, when is the risk of addiction, drug detox, drug rehab, injury, or even death, an appropriate one for a doctor to take?

3. When is the patient, if ever, fully informed and asked to contribute to the decision?

Somehow, apparently, doctors are supposed to know what constitutes an "appropriate" versus an "inappropriate" risk. I'm wondering if it's taught in med school, or if there's a handbook somewhere. I don't think so, but I could be wrong.

But decent doctors get trapped every day by lying, symptom-faking doctor-shoppers who con prescriptions out of them. Is the doctor guilty of "undue" risk? I don't know. These kinds of questions aren't answered in the DEA regulations. But doctors are often called up on charges that they over-prescribed or wrongly prescribed some controlled substance, usually resulting in addiction leading to drug rehab, injury, illicit prescription sales or sudden, unexpected deaths.

Thousands of prescription drug addicts hooked on narcotics like OxyContin or Vicodin will tell you that dependence or addiction leading to the need for drug rehab don't require an incompetent or unethical doctor. All that's needed is a supply of prescription narcotics taken exactly as prescribed, plus some quirk in your personal metabolism or something else - and in many of these cases, no one knows for sure. And that's an important point. No one, anywhere, knows for sure who will become addicted and who won't.

And because of this, no one really knows the impact that the little word "undue" should have on the potential culpability of physicians for patients who who take their prescriptions as directed, become addicted and end up in drug rehab, or worse. If I was a doctor, I'd be asking where the addictive nature of some prescription drugs ends and the "undue" risks begin.

As for the thousands of unfortunate prescription drug addicts who didn't go looking for addiction, I'd be thinking it might not be "undue" to talk to a lawyer about who's really responsible for the drug rehab program, along with certain pain and suffering. And I might be thinking Big Pharma. Wouldn't you?

Rod MacTaggart is a freelance writer who contributes articles on health.

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