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Prevention of substance abuse????
JOURNAL OF ADOLESCENT HEALTH 1996;18:1
EDITORIAL
Prevention of Substance Abuse????
In this issue of The Journal (1) we read of widespread abuse of nicotine among Japanese teenagers, which we have long known to be a problem throughout the world. Our concern about this phenomenon rests not only in our knowledge of the multitude of early and late medical complications of cigarette use, but also because of its role as a "gateway" drug, that is, one which leads to abuse of even more potent drugs. Studies by Kandel et al (2) alerted us to this problem more than twenty years ago, yet in the intervening years we have made little progress in prevention of substance abuse by teenagers. In the December 14th issue of Nature (3), I read with great interest of a study demonstrating that rats inoculated with a synthetic cocaine-like substance developed antibodies to cocaine. These antibodies were found to bind with cocaine, thus reducing its blood and brain levels. Although the authors appropriately urge caution against undue optimism with regard to implications for human application, it is tempting to speculate. Alan Leshner, Director of the National Institute on Drug Abuse, the agency that sponsored the study, was, for example, quoted in The New York Times as saying that the study offered "a very promising new direction in the search for a safe means of blocking the damaging effects of crack and cocaine" (4). What if a vaccine were ultimately developed which could block the sought-after pleasurable effects of cocaine and, potentially, other drugs? If, for example, teenagers did not experience a "high," might they be less interested in continuing use? If
there were such a vaccine, who should be "immunized"? Should it be the "high risk" youngsters? At first glance, that seems appropriate, but we have sadly learned through the experience with H.I.V. infection that many without so-called "risk" factors have contracted the disease. Moreover, if we could agree on the appropriate target population, we would then be faced with the equally difficult question of when the vaccine should be administered. With cigarette use often commencing as early as 10 years of age, it may be necessary to immunize in late childhood. What would parents think about that and what would be the message to their children, should they agree? As with many other scientific advances, this one leaves a host of ethical dilemmas in its wake. Iris F. Litt, M.D. Editor-in-Chief
References 1. Osaki Y, Minowa M. Cigarette smoking among junior and senior high school students in Japan. J Adolesc Health 1995; 18:58-64. 2. Kandel DB, Kessler RC, Margulies RB. Antecedents of adolescent initiation into stages of drug use: A developmental analysis. J Youth Adolesc 1978;7:13-40. 3. Rocio M, Carrera A, Ash]ey JA, et al. Suppression of psychoactive effects of cocaine by active immunization. Nature 1995;378:727-730. 4. Leafy WE. Scientists immunize rats against some effects of cocaine. The New York Times. Thursday, December !4, 1995.
© Society for Adolescent Medicine, 1996 Published by Elsevier Science Inc., 655 Avenue of the Americas, New York, NY 10010
1054-139X/96/$15.00 SSD| 1054-139X(95)00304-5
EDITORIAL
Prevention of Substance Abuse????
In this issue of The Journal (1) we read of widespread abuse of nicotine among Japanese teenagers, which we have long known to be a problem throughout the world. Our concern about this phenomenon rests not only in our knowledge of the multitude of early and late medical complications of cigarette use, but also because of its role as a "gateway" drug, that is, one which leads to abuse of even more potent drugs. Studies by Kandel et al (2) alerted us to this problem more than twenty years ago, yet in the intervening years we have made little progress in prevention of substance abuse by teenagers. In the December 14th issue of Nature (3), I read with great interest of a study demonstrating that rats inoculated with a synthetic cocaine-like substance developed antibodies to cocaine. These antibodies were found to bind with cocaine, thus reducing its blood and brain levels. Although the authors appropriately urge caution against undue optimism with regard to implications for human application, it is tempting to speculate. Alan Leshner, Director of the National Institute on Drug Abuse, the agency that sponsored the study, was, for example, quoted in The New York Times as saying that the study offered "a very promising new direction in the search for a safe means of blocking the damaging effects of crack and cocaine" (4). What if a vaccine were ultimately developed which could block the sought-after pleasurable effects of cocaine and, potentially, other drugs? If, for example, teenagers did not experience a "high," might they be less interested in continuing use? If
there were such a vaccine, who should be "immunized"? Should it be the "high risk" youngsters? At first glance, that seems appropriate, but we have sadly learned through the experience with H.I.V. infection that many without so-called "risk" factors have contracted the disease. Moreover, if we could agree on the appropriate target population, we would then be faced with the equally difficult question of when the vaccine should be administered. With cigarette use often commencing as early as 10 years of age, it may be necessary to immunize in late childhood. What would parents think about that and what would be the message to their children, should they agree? As with many other scientific advances, this one leaves a host of ethical dilemmas in its wake. Iris F. Litt, M.D. Editor-in-Chief
References 1. Osaki Y, Minowa M. Cigarette smoking among junior and senior high school students in Japan. J Adolesc Health 1995; 18:58-64. 2. Kandel DB, Kessler RC, Margulies RB. Antecedents of adolescent initiation into stages of drug use: A developmental analysis. J Youth Adolesc 1978;7:13-40. 3. Rocio M, Carrera A, Ash]ey JA, et al. Suppression of psychoactive effects of cocaine by active immunization. Nature 1995;378:727-730. 4. Leafy WE. Scientists immunize rats against some effects of cocaine. The New York Times. Thursday, December !4, 1995.
© Society for Adolescent Medicine, 1996 Published by Elsevier Science Inc., 655 Avenue of the Americas, New York, NY 10010
1054-139X/96/$15.00 SSD| 1054-139X(95)00304-5