Did The Opioid Epidemic Start With A Single Paragraph?

Canadian doctors' analysis of the literature says "yes"

Richard Root
June 01, 2017 - 5:43 am
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Buffalo, NY (WBEN) - It's estimated between 26 and 36 million people world-wide abuse opioids. Over 2 million people in the United States are estimated to be addicted to prescription opioid pain drugs. A letter in the New England Journal of Medicine today suggests the opioid epidemic originated, at least partly, due to one paragraph letter sent to the Journal 40 years ago.  

The letter was published January 10, 1980. It said out of nearly 12,000 hospital patients who were given narcotics for pain, only four developed an addiction, and only one of those was considered major. The author concludes "despite widespread use of narcotic drugs in hospitals, the development of addiction is rare in medical patients with no history of addiction."

Since that letter was published, it was been cited over 600 times, according to four Canadian doctors who analyzed the letter's usage.  The problem is the conclusion has been cited inaccurately for nearly four decades.  

Of the over 600 citations, nearly 500 of those neglected to mention the patients were hospitalized.

Dr. Hershel Jick, of the Boston University Medical Center at the time, wrote the letter, and he told the Associated Press he was "mortified" the letter was used as excuse by drug companies.

Citation of the letter increased significantly after OxyContin was put on the market. Twelve years later the manufacturer pled guilty to federal charges that they misled regulators, doctors, and patients about the risk of addiction associated with the drug.

The analysis published today concludes that the inaccurate citation of Doctor Jick's letter contributed to today's opioid crisis "by helping to shape a narrative that allayed prescribers’ concerns about the risk of addiction associated with long-term opioid therapy."

Dr. David Juurlink, of the University of Toronto, led the analysis and said "It's difficult to overstate the role of this letter" in today's opioid epidemic, calling it a key bit of literature which helped opiate manufacturers convince doctors addiction is not a concern.

The entire letter from 1980:

"Recently, we examined our current files to determine the incidence of narcotic addiction in 39,946 hospitalized medical patients1 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,2 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."

Original letter HERE.

You can read the analysis in the New England Journal of Medicine HERE.

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