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To the Editor: Dr McLellan and colleagues¹ state that drug addiction should be treated as a chronic medical disease. This contradicts our experiences as a sheriff (L.A.) and an emergency department physician (D.L.S.) who regularly encounter patients who provide false histories concerning trauma or pain syndromes, insist on narcotic analgesics, and vigorously refuse nonnarcotic analgesics or follow-up with an office-based physician. Our experience has been that the overwhelming majority of such patients will not agree to enter a drug rehabilitation program or to go to Alcoholics Anonymous or Narcotics Anonymous.

Anecdotally, most patients who have been in rehabilitation experience a relapse or a loss of control of their drug dependency. Only a tiny minority of these patients will follow up with a single physician or medical office for ongoing medical management of their chronic illness. The vast majority of drug-dependent individuals do not view their condition as an illness, but . . . [Full Text of this Article]

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