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Editorial Comment 6/25: “Susceptibles” and addiction injury

by William Haning, MD, DFAPA, DFASAM | June 25, 2019

Editorial Comment:  “Susceptibles” and addiction injury

Apart from the discussion of the Pennsylvania Society of Addiction Medicine's efforts to improve access to buprenorphine, legislatively, the topics this week focus on the needs of women, the newborn, and adolescents.  While we are all vulnerable – “we” being the global population - this emphasis recognizes a principle of resource dedication pertaining to susceptibility: interventions commonly focus first on those who are most acutely ill; yet this classical “triage” may need to be modified to consider long-term consequences and developmental injury.  Said differently, allocation of resources (money, people, training) may not be best prioritized according to the immediate, crisis-centered effects.

In one example in the British Medical Journal below- and while the importance of the distinction between the impacts of gabapentin and pregabalin awaits determination - the fact of an impact by both on adolescents requires respect when making medication decisions.  Similarly, the comment from Science Daily regarding the effect of cannabis on adolescents is a recurring theme in preventive medicine: that the injury from a substance’s use may be principally developmental, rather than acute. This differentiation is a particularly important one when arguing the case of the addicted patient before legislative policy-makers: that the most severe consequences of a given drug’s use may not lie in the immediate effects (e.g., opioid poisoning mortalities), but rather in the later effects on the fetus or on the child.  I bear in mind always the interval that was required to see the developmental impact of leaded gasoline fuel emissions on the U.S. population.*

*Nriagu J.O., The Rise and Fall of Leaded Gasoline, The Science of the Total Environment, 92(1990) 13-28. http://www.columbia.edu/itc/sipa/envp/louchouarn/courses/env-chem/Pb-Rise&Fall(Nriagu1990).pdf

-Editor-in-Chief: William Haning, MD, DFAPA, DFASAM