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The five-sentence letter that fueled the opioid crisis

By Karen Graham     Jun 6, 2017 in Health
The letter published in the New England Journal of Medicine in 1980 was only a paragraph long - five sentences, to be exact. However, what it said was miscited so many times it began to take on a life of its own, fueling today's U.S. opioid crisis
Over the past 20 years, the prescribing of strong opioids for the management of pain has increased dramatically in the United States and Canada. From 1999 through 2015, over 183,000 deaths from prescription opioids were reported in the U.S. and millions of Americans are now addicted to opioids.
We are now in the midst of an opioid crisis of unimaginable proportions and this may be partly due to physicians being told that the risk of addiction from opioids was rather low if being used for treating chronic pain.
There was one problem - the claim was based on a one-paragraph letter published in the prestigious New England Journal of Medicine by Jane Porter and Dr. Hershel Jick. The letter, entitled, "Addiction Rare in Patients Treated with Narcotics," was only five sentences long. Here is the letter in full: "Recently, we examined our current files to determine the incidence of narcotic addiction in 39,946 hospitalized medical patients who were monitored consecutively. Although there were 11,882 patients who received at least one narcotic preparation, there were only four cases of reasonably well-documented addiction in patients who had no history of addiction. The addiction was considered major in only one instance. The drugs implicated were meperidine in two patients, Percodan in one, and hydromorphone in one. We conclude that despite widespread use of narcotic drugs in hospitals, the development of addiction is rare in medical patients with no history of addiction."
However, that small letter was misquoted, miscited and taken as the truth by many physicians. It was also cited at least 600 times by pain specialists and some pharmaceutical companies like Purdue Pharma, who falsely claimed their OxyContin, was less addictive than other types of pain medicines.
West Virginia  a mountainous state of less than two million people  is among one of the hardest hit ...
West Virginia, a mountainous state of less than two million people, is among one of the hardest hit communities in the US which is facing an epidemic of opioid and heroin abuse
Brendan Smialowski, AFP
It all comes down to a rebuttal and a new study, of sorts, by a research team led by David Juurlink at the University of Toronto. The research team was able to trace the letter through the academic citation circuit, showing how the words of the letter became evidence that opioids were safe to use, reports The Atlantic.
The rebuttal correspondence was published in the New England Journal of Medicine, entitled: "A 1980 Letter on the Risk of Opioid Addiction."
"I think it's fair to say that this letter went quite a long way," Dr. Juurlink, who is head of clinical pharmacology and toxicology at Toronto's Sunnybrook Health Sciences Centre. He also noted that today, the letter would raise a lot of "red flags" and be torn apart on Twitter.
Dr. Juurlink points out the letter only described the effects of narcotic pain medications on hospitalized patients, and those medications aren't even being used today, even though the letter has been cited as proof that modern opioid drugs are safe to use.
"I don't think it mattered that it didn't say much, what mattered was its title and its publication, and those two things went a long way," Dr. Juurlink said.
As for the letter's author, Dr. Hershel Jick says he never intended for the article to justify widespread opioid use, saying, “That particular letter, for me, is very near the bottom of a long list of studies that I’ve done.”
Last month, Dr. Jick told the Associated Press, “I’m essentially mortified that that letter to the editor was used as an excuse to do what these drug companies did.”
More about opioid crisis, New England Journal of Medicine, miscited, Evidence, anecdote