In the 1980s, a highly respected physician wrote in the New England Journal of Medicine that out of close to 40,000 patients who were prescribed powerful pain medications in Boston, only four addictions were recorded.
Before that, doctors had been skeptical about opioids, thinking that it might get patients hooked on them, CBS News reports. Because of the letter, which said addiction was “rare” in those who had no history of addiction – despite having no supporting information – many doctors were reassured and began prescribing opioids. Dr. Hershel Jick, a drug specialist at Boston University Medical Center, wrote the letter.
This one-paragraph letter opened the door to what is now a nationwide epidemic of opioid misuse, including painkillers like Vicodin and OxyContin. The New England Journal of Medicine published an editor’s note on Wednesday with an analysis by Canadian researchers that tracked just how many times the letter has been cited: over 600 times, generally inaccurately.
Most of those who referred to the letter used it to validate that addiction to prescription opioids was “rare,” withholding the fact that the doctor in the letter focused on hospitalized patients only. Outpatients with chronic pain conditions came to be the majority users of painkillers.
Dr. David Juurlink of the University of Toronto, who led the analysis, said,
It’s difficult to overstate the role of this letter. It was the key bit of literature that helped the opiate manufacturers convince front-line doctors that addiction is not a concern.
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. They used this letter to spread the word that these drugs were not very addictive.” Jick clarified that his letter only referred to people who were given painkillers in the hospital for a short period of time, and had nothing to do with long-term outpatient use.
The editor’s note in the journal says, “For reasons of public health, readers should be aware that this letter has been ‘heavily and uncritically cited’ as evidence that addiction is rare with opioid therapy.”
