How One Letter Fed the Opiate Epidemic

In light of the Opiate Epidemic sweeping America, many citizens find themselves with questions. One of the most common questions: who is to blame for this? Now, Dr. Hershel Jick is the one finding himself answering to many. In 1980, Dr. Jick wrote a letter during his time with the Boston Collaborative Surveillance Program which has had a massive and fateful impact on how narcotic painkillers are being distributed in America.

The Letter

The letter, which could hardly be described as such, based on the fact that it equaled hardly more than a paragraph, stated that though narcotics were being widely used in hospitals all around the United States, addiction rates were found to be low in those who had no previous history of addiction. Additionally, the study that was conducted looked at patients who were hospitalized and therefore on a regimen of receiving these Opioid painkillers in a strictly regulated manner, overseen by medical staff. The letter was sent to the editor of the New England Journal of Medicine, where it was eventually published. The letter stated, in full:

Recently, we examined our current files to determine the incident 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 4 cases of reasonably well documented addiction in patient who had no history of addiction. The addiction was considered major in only one instance. The drugs implicated were meperidine in two patients, and Percodan in one, and hydromorphone in one. We concluded that despite widespread use of narcotic drugs in hospitals, the development of addiction is rare in medical patients with no history of addiction.

Dr. Jick never expected his testimony on a small study conducted with narrow specifications to become one of the most highly cited publications on narcotic painkillers, and yet, that is exactly what happened.

The Aftermath

As time went on, and pharmaceutical companies began to push Painkillers more, this paragraph would start to become cited continuously as a scientific testimony that doctors and patients need not worry about the addictive potential of these Opioid prescriptions. The notoriety of the New England Journal of Medicine was growing around this time due to the fact the it was frequently publishing groundbreaking studies, which is believed to have fueled the fire that led to this brief letter being used to push the pharmaceutical agenda.

While most articles published in the Journal were peer-reviewed and scientifically sound, this article was submitted in a section of the publication known as the “Correspondence” section. What this means is that the article did not receive peer review prior to it being included in that addition of the publication, but because the NEJM was considered a highly credible source for scientists, this short explanation of a simple study became blown far out of proportion. Certainly, the study is credible within the scope in which it was conducted, but when taken out of context, it implies a concept which is far from the truth- that prescription Opiates rarely cause addiction. Unfortunately, it was this cherry picking of facts by manufacturers and pharmaceutical reps that led to the current epidemic.

Righting Wrongs

Considering clear evidence that Opiates are in fact addictive, it became imperative that the doctor take actions to stop the spread of misinformation. “This has been a matter of a lot of angst for me,” Dr. Jick told a publication recently, when asked how he feels about the ramifications of that letter. Dr. Jick has taken every effort to ensure that his letter does not continue to give the impression that Opiates are safe, including an editor’s note added to the original letter which reads:

“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.”

In addition to the note, the letter is also linked to the most recent studies about the addictive potential of Opiates.

Despite the damage that’s already been done, new studies have been conducted and will continue to be, which will hopefully deter physicians and pharmaceutical companies from prescribing narcotic painkillers without exploring other options first. It is a long road to recovery for America and its Opiate dependent citizens, but progress is being made all the time.

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