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    Can we prediagnose opiate addiction?

    We have a serious public health problem called “opiate addiction.” It affects all age groups, and in the last 2 decades it has spread across the country. It used to occur only among the poor and minorities. Now it impacts everyone, even family members of those running for presidential office.

    More: The reality of oxycontin prescriptions for kids

    The medical community has contributed to the problem by using opiates for treatment of pain. Opiate addictions have a high death rate, particularly among those who use street drugs. Our government tries to manage this by limiting pain prescriptions. Police and firemen do their best by using Narcan or similar drugs as an antidote against overdose.

    Those who are severely addicted require expert management, but I believe we may be able to identify those not severely ill by diagnosing those who are predisposed. This essay is about the benefits of and the time needed to take an adequate personal and family history before patients develop opiate addictions.

    What would it take to discover risk factors that predispose patients to opiate addiction? My premise is the need to spend more time taking comprehensive family histories. Perhaps the “real patient” might be what a few thinkers refer to as “the 3-generation family system.”

    Insights into the family tree

    Thomas H. Lee, MD, MSc, of Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, in his 2014 article “Time after time—health policy implications of a three-generation case study,” wrote about 3 generations of a single family cared for by the same primary physician. The physician recognized that similar issues kept arising with discouraging predictability.

    According to Lee: “This three-generation case study shows the intertwined effects of poverty, depression, alcoholism, drug addiction, unemployment, domestic violence, and occasionally incarceration on individual family members and the family as a whole. Each family member was born into a chaotic social context, social [and perhaps] genetic factors combined to lead to a downward personal spiral.”

    Unlike the victims with backgrounds cited by Lee, many victims now come from middle- and upper-class families, and have been given legitimate painkiller prescriptions. But even in upscale families, addictions and other dysfunctions often pass from 1 generation to the next. Lee concludes that if pediatricians intervene in the first or second generation, we can favorably affect health, discovering meaningful signs of addiction in earlier generations that might have been overlooked. He felt it’s our best hope for ensuring that 1 or 2 generations from now, the story line of patients’ families might be a different one.

    In short, if you take a multigenerational perspective, you can demonstrate risk factors for family dysfunction. May I suggest that we place ourselves at significant disadvantage if we see our real patient as only the child or the adolescent? I believe it is more useful to consider that the real patient could be the multigenerational family system.

    NEXT: The power of listening

    Howard King, MD, MPH
    Dr King, a board-certified pediatrician, is founder and director of the Children’s Emotional Health Link, and honorary member of the ...


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