Prior to 2020, everyone wanted to claim Big Pharma and medicine were bad, so whatever they wanted to write about got a broad misuse umbrella; misuse, abuse, medication errors were all called misuse. All such deceptive framing accomplished was to muddy the waters and create a clear need for classifying and selecting terms and definitions to understand which situations truly involve medicine misuse.
A new systematic review looked at 51 relevant studies from 2008 to 2020 and found there were 74 examples of misuse - with 71 definitions.
"A novel, consensual and standardised definition of medicine misuse is required," the authors write. "Such a taxonomy could include the different key elements highlighted in the present review, namely initiator, intent, purpose and context of medicine misuse."
When a meaning is so broad it can be “intentional or unintentional prescribing not in line with clinical evidence” it can mean a mistake rather than misuse. It can also mean when a patient insists they have a condition. Rarely does it mean doctors handing out stimulants or opioids to recreational users for years, but in the literature it can be hard to know what is meant by misuse.
Basically the patient, prescriber and pharmacist are not all equal in this chain so considering all of them equal parts in medical misuse helps no one. A pharmacist has the job of filling a prescription and notifying the patient of warnings that are on the label. A doctor can be fooled by a patient and subconsciously, when the cultural landscape is a giant defensive medicine bill and a Twitter storm because they refused a prescription, can choose to believe the best.
An example they use is a bit extreme, lorazepam for over 30 days to prevent insomnia. It's an anxiety medication, not a sleeping aid, so benzos will generally be a waste of money, and it shouldn't be taken long-term. Has that ever happened anyway? Sure, but those are real outliers. The true medical misuse is not doctors handing out pills like candy, with the 'science is a corporate conspiracy' intonation that pharmaceutical companies are buying off physicians, but rather patients who believe they have chronic lyme disease or something they got from eating corn syrup made from maize that has been genetically optimized. They want to be validated, and for that they need to have medication. Misuse from self-diagnosis and for recreation has real consequences for legitimate issues. Ask the doctors of cancer patients how they feel about government treating them like criminals if people in pain are given more medication than an arbitrary standard created by a panel staffed by people who hate pharmaceutical companies dictates.
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