Comment

“pseudo-addiction”, make the point that problematic drugrelated behaviour has a differential diagnosis with profound implications for treatment. Finally, they highlight the need for careful monitoring and appropriate referral of the patient. However, the document1 regrettably provides little practical guidance on selection of patients, structuring of therapy to enhance monitoring and control, or strategies to manage patients whose problematic behaviour is not severe enough to warrant specialist referral. It includes an unsubstantiated statement that short-acting opioids predispose to tolerance and dependence, and sadly neglects the problem of severe chronic pain in patients with known chemical dependency. 8 For an American physician, this document is, on balance, all about balance, and deserves praise as such. Clinicians will need other resources to become educated about the important issues it raises. 9