A One-Paragraph Letter From 1980 May Have Fueled The Opioid Epidemic

By Kelly Burch 06/05/17

A brief, wrongfully cited report in a medical journal from 1980 played a major role in the opioid crisis as we know it.

Image: 
A pair of hands holding a mound of white pills.

A short, one-paragraph letter published in 1980 in The New England Journal of Medicine made a big impact on the growing opioid epidemic, according to a group of Toronto researchers. 

In a new letter to the editor in the same journal, the team led by David Juurlink of the Sunnybrook Research Institute of Toronto wrote:

“We found that a five-sentence letter published in the Journal in 1980 was heavily and uncritically cited as evidence that addiction was rare with long-term opioid therapy. We believe that this citation pattern contributed to the North American opioid crisis by helping to shape a narrative that allayed prescribers’ concerns about the risk of addiction associated with long-term opioid therapy.”

Juurlink and his peers found that the original letter was cited 608 times in the scientific literature. In 72% of the articles that referenced the 1980 letter, it was used to support the claim that opioids were not addictive. 

“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 1980 was widely invoked in support of this claim, even though no evidence was provided by the correspondents,” the editorial reads. 

The letter that was published in The Journal in 1980 was not a study, but a report by Jane Porter and Hershel Jick of Boston University Medical Center. The entire text of the letter is as follows

“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.”

According to the new editorial, the widespread citation of the letter was irresponsible and damaging. “Our findings highlight the potential consequences of inaccurate citation and underscore the need for diligence when citing previously published studies,” authors wrote. 

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Kelly Burch writes about addiction and mental health issues, particularly as they affect families. Follow her on TwitterFacebook, and LinkedIn.

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