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[Correspondence] Additive burdens of malnutrition, poverty, and substance abuse

In Hélène Delisle and Malek Batal’s correspondence (June 18, p 2504),1 the authors eloquently noted the dual burdens of undernutrition and overnutrition among socioeconomically disadvantaged populations. However, one important and rapidly increasing group merits further comment. More than 2·5 million Americans abuse heroin or prescription opioids,2 leaving the USA in the midst of an opioid abuse epidemic. The adverse consequences of illicit opioid use (eg, overdose, infectious disease, premature death) are widely discussed.