Editorial Comment 5/28: Memorial Day; Sublocade and Brixadi
Editorial Comment: Memorial Day; Sublocade and Brixadi
28 May: 1) Memorial Day and the experience of alcohol in the military; 2) competing buprenorphine preparations.
1. For the years that I have been with the Weekly, I have been grateful to the ASAM staff leadership for observing Memorial Day. It is one day that I’ve always taken more seriously than those associated explicitly with other historical events. Mention of it here has particular significance, given the long association of alcohol use with military service. That use is not coincidental. It reflects in some respect alcohol as a performance drug, in others a matter of tradition. Few in this field are unfamiliar with some version of an 1863 New York Times story, regarding Ulysses Grant: “…when someone charged Gen. Grant, in the President’s hearing, with drinking too much liquor, Mr. Lincoln, recalling Gen. Grant’s successes, said that if he could find out what brand of whisky Grant drank, he would send a barrel of it to all the other commanders.” But probably most poignantly it commonly represents a susceptibility that is passed from one generation to another. Military service has long been a precinct of families; and I believe it has been no accident that so many of my uniformed patients can track the influence of alcohol in their lives to their fathers, to their grandfathers, to distaff antecedents.
On this day, there deserves acknowledgment of the military’s initiatives in addressing the illness. The services have been frequently chastised for their failure to provide treatment consistently, or to recognize rehabilitation as taking precedence over retribution; but in fairness, the military has not been behind the civilian community in this matter, and often ahead of it. In the 1960s and 1970s, perhaps the brightest light in the residential recovery movement outside of Minnesota was at Naval Hospital, Long Beach, California, in an unauthorized program held in a commandeered barracks building. Captain Joseph J. Zuska, of the Navy Medical Corps, passed away almost exactly 12 years ago at age 93, began the program; and with Captain Joseph A. Pursch, the two senior physicians tirelessly developed an understanding of diagnosis, intervention, and recovery within the Naval and Marine Corps line, as well as in the medical services. ASAM recognized Captain Pursch with the R. Brinkley Smithers Award in 2001. Not so long after and 2500 miles to the left (west…), Dr. Terry K. Schultz returned to active Army duty specifically to set up a premier treatment program and training fellowship at Tripler Army Medical Center, in Honolulu. He deftly brought his more biologically-oriented colleagues around to the notion of addiction as a disease by correctly representing it as at least neurobiological in origin. Ultimately serving as the Army Surgeon-General’s Consultant for Addictions and retiring as a Colonel, Terry was instrumental with Dr. Allan W. Graham and Ms. Bonnie Wilford in creating and publishing Principles of Addiction Medicine (ASAM), now in its 6th edition.
2. Sublocade and Brixadi: The following is a National Public Radio (NPR)investigation of the proposed delay in release of a second extended-release, injectable form of buprenorphine. Published and broadcast this past Friday, it reviews the FDA decisions and both the legal and commercial bases for the expected delay.
- William Haning, MD, DFAPA, DFASAM