Bill Haning MD
EDITORIAL COMMENT: Contagion
This promised comment on contagion follows on the August 21 editorial comments, about market forces in the distribution of drugs.
If we consider drug distribution within a public health framework as an example of contagion, then we are bound to see some important similarities between the spreads of substance use and of infectious disease. These may be useful. For example, contrasting the characteristics of influenza against those of highly-popular euphorigenics (sic), such as methamphetamine, parallels are immediately discerned:
Infection characteristics (e.g., influenza)
- Contagious (human-to-human, animal-human, etc.)
- Parasite cannot too swiftly incubate or kill the host (or contagion may be interrupted, as with Ebola, Marburg, Lassa)
- Ease of infection assures prevalence (determinants are susceptibility of the population, and route of transmission; thus Hansen’s disease is limited in both impact and spread yet can persist in a population for generations)
- Geographic spread follows lines of commerce (as well as lines of migration and invasion; typhus, cholera in war)
- The most dramatic effects may be acute (abrupt disability or death); however, the greatereconomic effect may be seen with contagions that result in chronic or recurrent disease (e.g., tuberculosis, malaria, hookworm [anemia])
Drug characteristics (e.g., methamphetamine)
- Contagious (users beget users)
- “Performance drug” precedes disability or lethality
- Inhalation/injection induces rapid dependence
- Market forces and lines of commerce determine distribution (e.g., Hawai`i sits astride trade routes from Korea and the Philippines, less so South America; thus methamphetamine use in Hawai`i has long overshadowed cocaine use)
- The most dramatic effects are those which capture the public’s attention, and are acute (e.g., motor vehicle collisions, death by opioid overdose, amphetamine psychosis); however, as in infectious disease contagion, the greater economic and social integrityimpacts are allied with chronic disease (e.g., debility/disease from tobacco use, disability from chronic intoxication or work injuries, diversion of economic resources, imprisonment and disenfranchisement of up to 2% of the working population).
Examining those similarities allows us to seek interventions that both consider market forces,and which overlap with an understanding of contagion. An evident example would be aggressive substance use disorder (SUD) treatment intervention during and after incarceration. Making SUD treatment the primary focus of imprisonment, probation, and parole 1) increases return-to-work rate on release, yielding improved productivity and social/family integrity; (2) makes use of an otherwise unproductive interval, generally measured in years; 3) reduces contagion between inmates; 4) markedly reduces drug (primarily opioid) overdose and death rates on discharge. Where there is a reservoir of illness, it offers the least expensive and most direct interventional target. I suspect many among you have wanted to be Dr. William Gorgas, pouring kerosene on Anopheles-breeding stagnant pools, and draining swamps* in Panama; or John Snow unscrewing the handle of the Broad Street pump. Our penal system is our reservoir.
*[No, I mean really. Really draining swamps.]
Very interesting comparison of addiction & contagious infectious diseases