The excellent article by Cox Hayley et al1 in the February 12, 1996, issue of the ARCHIVES offers practical insight into the management of ethical and legal issues faced by the practitioner caring for nursing home residents. However, there is one point that requires further clarification. Provisions for the proper use of neuroleptics are incorporated in the "Interpretative Guidelines for 'Unnecessary Drugs'." The Unnecessary Drug regulations, which are part of OBRA (Omnibus Budget Reconciliation Act) 1987, assure nursing home residents that they have a right to be free from the use of unnecessary drugs, which are defined as medications used in excessive doses (including duplicative therapies), for an excessive duration, without adequate monitoring, in the presence of adverse consequences that indicate the dose should be reduced or discontinued, or a combination of any of the above.2
Cox Hayley and colleagues state that "neuroleptic use on an as-needed basis