Medication use in an imperfect world: drug misadventuring as an issue of public policy, Part 1.

Drug misadventuring is defined, applicable public policy issues are identified and analyzed, and recommendations are suggested for reducing the magnitude and scope of drug misadventuring. The extensive use of pharmaceuticals in the United States, as well as the error-prone systems that are responsible for the appropriate preparation and distribution of drugs, has created new challenges for prescribers, dispensers, and users of drugs. The term "drug misadventuring" covers the broad array of phenomena associated with negative drug experiences. Studies conducted in the United States during the past two decades related to drug misadventuring have been inadequate. Further, extrapolation of data from these studies to the population at large has yielded false projections of the extent of the problem. Since drug misadventuring is a human problem, it is derived from the actions or inactions of a variety of "environments"--social, economic, political, and scientific-technological--that define American society. The following players directly influence decisions associated with drug misadventuring: prescribers, patients, pharmacists, manufacturers, policymakers, and third-party payers. Conflicts of interest among these groups and environmental sectors deter progress in minimizing drug misadventuring. The problem of drug misadventuring must be viewed as a problem in public policy, and new policy decisions must be constructed in the best interest of the patient. Recommendations are made for a "new order" in confronting and resolving this problem. Bold leadership and forthright discussion will be required to find solutions to the problem of drug misadventuring.