Addiction Rare in Patients Treated with Narcotics

"Addiction Rare in Patients Treated with Narcotics" is the title of a letter to the editor published in The New England Journal of Medicine. Having examined records of patients treated with narcotics in a hospital setting, the authors concluded that this rarely led to addiction. This letter has since been frequently misrepresented to claim that opioids are not addictive when prescribed for use at home, which has been blamed for contributing to the opioid epidemic in the United States.

Origin

Written by Jane Porter and Hershel Jick, the five-sentence letter was published in the January 10, 1980, issue of The New England Journal of Medicine. Its text read, in its entirety:

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.[1]

Influence

Fearing addiction, doctors had often been hesitant to prescribe narcotics for pain, even serious chronic pain.[2] Porter and Jick, as the letter came to be known,[3] was later cited frequently as evidence that prescription painkiller addiction was very rare.[4][5] Until full journal archives were placed online in 2010, the letter itself was perhaps not readily accessible, so many of those who cited it may not have actually read it.[6] It was thus perhaps overlooked that the patients in question were all given opioids in small doses in a hospital, not as long-term prescriptions to take on their own.[4][5] Additionally, in 2003, Jick told The New York Times that the study did not follow patients after they left the hospital.[2]

In 2017, The New England Journal of Medicine published a bibliographic analysis of the letter showing that it had been cited 608 times since it was published. In comparison, the other letters to the editor in the same issue of the Journal as Porter and Jick's letter had been cited a median of 11 times.[7] Of these 608 citations, the analysis also showed that 72.2% of them cited it in support of the claim that patients treated with opioids rarely developed addiction, and 80.8% did not mention that the letter only included data on prescriptions given to hospitalized patients.[8] It was also misrepresented in the popular media; a 1990 Scientific American article described it as an "extensive study," and a 2001 Time story dubbed it a "landmark study" showing that concerns about opioid addiction were "basically unwarranted."[6] In addition, Purdue Pharma, the manufacturer of OxyContin, trained its sales representatives to say that the risk of addiction among patients using the drug was less than one percent, citing Porter and Jick's letter as one of their sources.[9]

Such misrepresentations have been blamed for contributing to the opioid epidemic.[5][10] David Juurlink, a co-author of the 2017 bibliographic analysis, has stated that he thinks the letter's appearance in a prestigious journal helped convince doctors that opioids were safe, saying, "I think it's fair to say that this letter went quite a long way."[11] Hershel Jick, who co-wrote the letter, said that it was of little consequence at the time, and drug companies later misused it to market new pain drugs.[12]

See also
  • Woozle effect

References
  1. Porter, J.; Jick, H. (10 January 1980). "Addiction Rare in Patients Treated with Narcotics". New England Journal of Medicine. 302 (2): 123. doi:10.1056/NEJM198001103020221. PMID 7350425.
  2. Meier, Barry (25 November 2003). "The Delicate Balance Of Pain and Addiction". The New York Times. Retrieved 24 June 2017.
  3. Hawkins, Derek (2 June 2017). "How a short letter in a prestigious journal contributed to the opioid crisis". The Washington Post. Retrieved 24 June 2017.
  4. Jacobs, Harrison (26 May 2016). "This one-paragraph letter may have launched the opioid epidemic". Business Insider. Retrieved 24 June 2017.
  5. Kounang, Nadia (1 June 2017). "One short letter's huge impact on the opioid epidemic". CNN. Retrieved 24 June 2017.
  6. Zhang, Sarah (2 June 2017). "The One-Paragraph Letter From 1980 That Fueled the Opioid Crisis". The Atlantic. Retrieved 24 June 2017.
  7. Kaplan, Karen (31 May 2017). "How a 5-sentence letter helped fuel the opioid addiction crisis". Los Angeles Times. Retrieved 25 June 2017.
  8. Leung, Pamela T.M.; Macdonald, Erin M.; Stanbrook, Matthew B.; Dhalla, Irfan A.; Juurlink, David N. (June 2017). "A 1980 Letter on the Risk of Opioid Addiction". New England Journal of Medicine. 376 (22): 2194–2195. doi:10.1056/NEJMc1700150. PMID 28564561.
  9. Van Zee, Art (February 2009). "The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy". American Journal of Public Health. 99 (2): 221–227. doi:10.2105/AJPH.2007.131714. PMC 2622774. PMID 18799767.
  10. Engber, Daniel (11 June 2017). "Bad Footnotes Can Be Deadly". Slate. Retrieved 24 June 2017.
  11. "Opioid crisis: The letter that started it all". BBC News. 3 June 2017. Retrieved 24 June 2017.
  12. Haney, Taylor (16 June 2017). "Doctor Who Wrote 1980 Letter On Painkillers Regrets That It Fed The Opioid Crisis". NPR. Retrieved 24 June 2017.
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