Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: In her Editorial about the possible
causal mechanisms of drug addiction, Dr Kandel1 did
not discuss the risk associated with prenatal administration of opiates or
sedatives. Several studies2-4 have
found that administration of these drugs during labor is a risk factor for
later addiction in adolescence or adulthood. Not only have these studies found
a dose-response relationship between drug exposure and subsequent risk of
drug addiction, but also have the advantage that the perinatal drug exposure
is limited to a few hours during birth. This restricts the range of confounding
factors (eg, socioeconomic status or residential environment5,6)
that can possibly moderate this long-term effect. Since any drug administered
prenatally would be expected to cross the placenta about equally to twin fetuses
irrespective of whether they are monozygotic or dizygotic twins, such an explanation
is consistent with the observation that no differences were found between
these 2 categories of twins in the recent study by Lynskey et al.7 Epidemiological studies that do not assess or control
for proximate factors on subsequent drug addiction may have a limited ability
to examine the effects of other causal factors occurring later in the drug
Anand KJS. Early Exposure to Marijuana and Risk of Later Drug UseEarly Exposure to Marijuana and Risk of Later Drug Use. JAMA. 2003;290(3):330. doi:10.1001/jama.290.3.330-a
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