The nonmedical use of prescribed controlled substances has become a major public health problem. This article reviews the extent of prescription drug abuse reflected in drug overdose deaths, youth drug use and drug-impaired driving. Efforts to reduce illegal, nonmedical use of prescribed controlled drugs must be balanced so as not to interfere with appropriate medical use of these medicines. Future policy options include identifying and expanding leadership in the research and medical communities, creation of a national public education campaign, development of abuse-resistant drug formulas, increasing prescription drug monitoring programs and enforcement efforts, establishing effective drugged driving laws, and improving substance abuse treatment.