Prescription opioids were initially used as a panacea for all kinds of pain problems. The news of opioids being the ultimate solution to the critical and prolonged pain is the outcome of an erroneous citation of a letter published in the New England Journal of Medicine in 1980.
Authored by Dr. Hershel Jick, a drug expert at Boston University Medical Center, the letter contained information about roughly 40,000 patients being prescribed powerful analgesics in a Boston hospital, with only four cases of opioid dependence. Prior to the letter being issued, doctors were apprehensive that the addictive effects of opioids would get patients hooked onto them. Blind faith in the credentials of the letter resulted in non-examination of the details published. Assured by the claims that addiction was a rare outcome of pain medicine recommendation, American doctors started advising pain relievers to their patients. The fact that some doctors prescribed more than what was necessary also resulted in the opioid epidemic.
The fact that the letter contained no added information to support the claims of opioids being safe resulted in indiscriminate prescription and abuse of drugs like Vicodin and OxyContin. An editor’s note, published in the New England Journal of Medicine on May 31, 2017, talked about the reach of the letter and said that it was cited repetitively, as many as 600 times, often wrongly. People reiterating prescription medicines being the ultimate care for pain management used the contents of the letter as evidence of addiction possibility being rare. In addition, most articles on opioids had failed to mention if opioid prescription must be limited to only hospitalized patients or if they could be handed out to outpatient chronic pain patients complaining of backaches and serious arthritis problems.
One citation said, “This pain population with no abuse history is literally at no risk for addiction,” while the other said, “There have been studies suggesting that addiction rarely evolves in the setting of painful conditions.” Senior author of the note Dr. David Juurlink from the University of Toronto 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.”
The editor’s note in the journal said that the contents of the letter were “heavily and uncritically cited” as proof that addiction problems are uncommon during opioid therapy. Dr. Jeffrey Drazen, editor-in-chief of the Journal, said, “People have used the letter to suggest that you’re not going to get addicted to opioids if you get them in a hospital setting. We know that not to be true.”
Commenting on how the contents of the letter were looked upon as a business opportunity by some drug manufacturing and marketing companies, 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.”
He confirmed that while penning his letter to the journal, he had referred to patients who were hospitalized and received opioid medicines only for a limited period. Apart from this, the observations regarding the effect of opioids as mentioned in the letter had no relevance to prolonged outpatient use.
Opioid use rose in the 1990s when opioid drugs like OxyContin hit the market. Misinterpretation of the content of the letter coupled with falsification by drug companies fueled opioid abuse.
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