A five-sentence letter published in 1980 by the New England Journal of Medicine that downplayed the potential for addiction from opioids was used for decades as supporting, if not primary, evidence for the safety of prescription pain medication.
Researchers in Canada analyzed how often medical professionals and scientists cited the letter, written by Dr. Hershel Jick, a drug specialist at Boston University Medical Center, and a graduate student, in arguments and research purporting the low risk for addiction of opioids since its publication. They included their findings in a letter to the editor of the New England Journal of Medicine published this week.
The Canadian researchers found that from 1980 to March 30, 2017, there were over 600 citations of the 1980 letter, with “a sizable increase after the introduction of OxyContin in 1995.”
The opioid epidemic in America stemmed from over-prescription of pain medications in the 1990s. Nearly 500,000 people died from an opioid drug overdose from 2000 to 2015, and nearly six in 10 drug overdoses involve an opioid.
Over 70 percent of articles that cited the letter used it as evidence that addiction was rare in patients treated with opioids. The Canadian researchers said authors of 491 of 608 articles did not accurately cite the letter, leaving out that the patients described in the letter as being treated with opioids were hospitalized.
“Some authors grossly misrepresented the conclusions of the letter,” the researchers wrote. “The crisis arose in part because physicians were told that the risk of addiction was low when opioids were prescribed for chronic pain. A one-paragraph letter that was published in the Journal in 19803 was widely invoked in support of this claim, even though no evidence was provided by the correspondents.”
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