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In this Aug. 5, 2010 file photo, a pharmacy tech poses for a picture with hydrocodone bitartrate and acetaminophen tablets, the generic version of Vicodin in Edmond, Okla. Photo: Sue Ogrocki, AP File

More than 183,000 Americans died of opioid overdoses between 1999 and 2015. You probably know one or more of the victims. The problem has become so widespread that cops in many hard-hit areas carry anti-overdose drugs to administer on emergency calls. The Ohio Attorney General even filed a massive lawsuit against five of the leading opioid manufacturers on Wednesday, alleging the state’s part of the tragedy was caused by the aggressive pharmaceutical companies.

Could this avalanche have started with the slightest of tipping points: a five-sentence, 100-word letter published in The New England Journal of Medicine in 1980?

That short missive triggered the massive prescription problem that has now become one of the key health crises of our time, says a new study in the same journal, 37 years later.

The title of the 1980 letter: “Addiction rare in patients treated with narcotics.”

The two doctors, Jane Porter and Hershel Jick, concluded that only one percent of a group of patients at Boston University Medical Center treated with opioid painkillers became addicted. Out of 11,882 patients who were administered at least one narcotic painkiller, only four got hooked, they concluded.

But left out of the 100-word research letter: how addiction was characterized, and also any look into managing chronic pain in an outpatient setting.

The new look into the effects of that short letter was conducted by Canadian researchers at Sunnybrook Health Sciences Centre and the Institute for Clinical Evaluative Sciences.

They plunged into the medical literature, watching how often it was cited, and how influential it became in consequent research.

Standard research letters of the same kind are cited an average of 11 times. The terse opioid letter: 608 times.

“For a letter to the editor, it’s almost unthinkable,” said David Juurlink, who led the bibliometric analysis.

The NEJM research letter became foundational for future drug research and policymaking. Three-quarters of the articles that cited the letter affirmed the non-addictive properties of opioids. More than 80 percent did not mention that the letter applied only to hospitalized patients, and not those in an outpatient setting.

Prior to the 1980 letter, doctors had been hesitant to prescribe certain painkillers – due to fears of addiction. But the letter opened the door to a whole new market, they said.

“Overcoming that fear was a critical strategy for those who thought opioids were underused for chronic pain, including opioid manufacturers,” said Juurlink, in a statement. “It now appears that hundreds of publications helped them do just that, by repeatedly citing a study that doesn’t’ tell us anything about that risk.”

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