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Addiction Nature versus Nurture –Which? Both?

flying cadeuciiFor those of you who missed the first essay in this series, on the genetics of addiction, in all of us there is a genetic code, a code, which along with billions of other variations , contains a fairly common single gene genetic variation , the Folic Acid ( Vitamin B9) transport gene, which we can test for, using a cheek swab.

This deficient/diminished Folic Acid transport gene variation, present in many of us, slows or halts the transport of folic acid into our brains, predisposing us to lifetime depression and , in many cases, into early drug or alcohol experimentation, in an attempt to “feel better”. Why?

Folic acid is required by the brain in order to construct the neurotransmitter substances; Dopamine, Norepinephrine, and Seratonin. So, too little or no Folic acid present ,and too little or no brain neurotransmitters get constructed, and the patient’s darkened mood reflects that lack. Experimentation often follows early and often in such patients’ lives.
As most of you know, I run a Suboxone Clinic as well as a standard general practice, and I have yet to discover a Suboxone Clinic patient who transports Folic Acid normally from blood stream into their brain.

I have had almost one hundred percent of the Suboxone Clinic patients tested, and all are either poor Folate transporters or very poor Folate transporters. Not a single “normal”, has surfaced, to date.

Even more compelling, all of the Suboxone patients, almost without exception, experimented with alcohol or drugs beginning at an early age and I/we are looking at the sequelae, the consequences.
It doesn’t help that all of us believe that we can “fix ourselves” and “control ourselves” , so that a “short term self administered trial” with drugs or alcohol is entirely voluntary and is easily reversible .

Unfortunately, as with most such fantasy based, clinical evidence lacking/clinical evidence absent self prescribing experiments, the failure rate is high , the reversibility rate approaches zero, and the subsequent substance addiction/abuse rate approaches 100 %

Ignorance rules, and addiction /overuse follows very quickly. As is often the case, ignorance can be fatal. You need only open today’s paper to read about it Add in two other factors;

1. Poor folate transporters appear to be attracted to each other far more often than to “normals” , so the genetics carry forward in family after family ,

2. Poor folate transporters are drawn to other addictive pursuits, risk taking and service to others being common.

So, many of our cops and firemen and doctors and EMTs, and nurses are poor folate transporters. Many of these people are tee totallers, having observed their family substance abusive behaviors and rejected them, but some are users/abusers, while still trying to do good deeds around themselves.

Serious problems may be the result. The tech at Exeter Hospital who quietly gave a number of patients Hepatitis C while arranging/diverting their pre-op opioid meds into his own veins comes to mind. Addicted cops and firemen abound. There was a general housecleaning recently in the Farmington Fire Department following allegations of widespread drug use by Department members.
OK, the problem is huge, and fatalities are skyrocketing, So, what do we do? Fentanyl appears to be the “new Budweiser”, but most Budweiser abusers survived their youth. (in my era, alcohol was the drug of choice, and although drunk driving deaths occurred, they did not number in the hundreds, but clearly, that is no longer the case) About 1000 NH kids will die this year from Fentanyl laced Heroin, if trends continue. Relatively few Fentanyl/heroin abusers survive their overdoses. There has been a Paradigm change. Kids have always believed they are immortal. Fentanyl proves otherwise. The result in this election year? Huge (but dangerously under/uniformed) Statewide discussions are underway at the State level as politicians/bureaucrats who have no hands on experience in any of this .but wish to be seen “ doing something” vie for headlines. “In patient Rehab”! “Massive counseling outlays”!
ie, There is talk of a massive increase in inpatient detox/rehab clinics, and other such highly visible but very expensive effforts. Nobody seems to have read the actual outcome stats for inpatient or outpatient drug rehab programs when revisited a year later (less than 5% long term adherence)

The” Doctor’s Prescription”?

1.If we discard “ cure” as a goal, and settle for “stabilization”, much as we do with Diabetes, we can begin to make some inroads. At the very least, we will have stopped believing in magic and switched to fact based decisionmaking

2. If we test all children entering kindergarten for Folic acid transport , and have an intensive lower level education program, detailing the miserable life altering life ending drug use outcomes, including an education program for parents and children, which continues for as long as we have that child in school, maybe we stop the majority of youthful wannabe experimenters from commencing opioid abuse.

3. We need to get the “quick buck merchants” out of this game. The new game would be to sit and figure out how to get the best, as in the best proven and stabilizing educational and behavioral services to the largest number of at risk kids and adults , to work very hard on Prevention, and stay with the already addicted for as long as it takes

4. Cease taxpayer support of methadone clinics . They are illogical, given our goals, and very very expensive Methadone is intoxicating and , thus inappropriate for our purposes. Many many auto accidents have occurred amongst this population.

5. Examine the cost drivers that make Suboxone programs so expensive ,and either create a State run lab or contract with a private lab or labs to bring these costs down

6. Ditto the price and thus the supply of Suboxone, which is a generic drug. There is no reason , other than greed, which makes iSuboxone so expensive.

Terry Bennett is a physician based in New Hamspshire.

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