In light of the opioid epidemic in the United States, many citizens are faced with questions. One of the most common questions: who is to blame for this? Now, Dr. Hershel Jick is the one answering many. In 1980, Dr. Jick wrote a letter during his time at the Boston Collaborative Surveillance Program that has had a massive and fatal impact on how narcotic pain relievers are distributed in America.
The letter
The letter, which could hardly be described as such, based on the fact that it barely amounted to a paragraph, stated that although narcotics were widely used in hospitals across the United States, addiction rates were found to be low in those who did not. had a history of addiction. Furthermore, 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, supervised by medical personnel. The letter was sent to the editor of the New England Journal of Medicine, where it was eventually published. The letter read, in its entirety:
We recently examined our current files to determine the incident of narcotic addiction in 39,946 hospitalized medical patients who were consecutively monitored. Although there were 11,882 patients who received at least one narcotic preparation, there were only 4 reasonably well-documented cases of addiction in patients who had no history of addiction. Addiction was considered significant in only one case. The drugs involved were meperidine in two patients, Percodan in one, and hydromorphone in one. We conclude that despite the widespread use of narcotics in hospitals, the development of addiction is rare in medical patients without a history of addiction.
Dr. Jick never expected that his testimony in a small study conducted to strict specifications would become one of the most cited publications on narcotic pain relievers, and yet that is exactly what happened.
The consequences
As time passed and drug companies began pushing painkillers more, this paragraph would begin to be continually cited as scientific testimony that physicians and patients need not worry about the addictive potential of these opioid prescriptions. The notoriety of the New England Journal of Medicine was growing at this time due to the fact that it frequently published groundbreaking studies, which is believed to have stoked the fire that led to this short letter being used to further the pharmaceutical agenda.
While most of the articles published in the journal were peer-reviewed and scientifically sound, this article was submitted in a section of the journal known as the “Correspondence” section. What this means is that the article did not receive a peer review before it was included in that publication addendum, but because the NEJM was considered a highly credible source for scientists, this brief explanation of a simple study is it came back very disproportionate. . The study is certainly credible within the scope in which it was conducted, but when taken out of context, it implies a concept that is far from the truth: that prescription opioids rarely cause addiction. Unfortunately, it was this selection of facts by pharmaceutical manufacturers and representatives that led to the current epidemic.
Fix errors
Given the clear evidence that opiates are in fact addictive, it became imperative that the physician take steps to stop the spread of misinformation. “This has been a source of great distress for me,” Dr. Jick said in a post recently, when asked how he felt about the ramifications of that letter. Dr. Jick has gone to great lengths to ensure that his letter no longer gives the impression that opiates are safe, including an editor’s note appended to the original letter that reads:
“For public health reasons, readers should be aware that this letter has been cited ‘strongly and uncritically’ as evidence that addiction is rare with opioid therapy.”
In addition to the note, the letter is also linked to the most recent studies on the addictive potential of opiates.
Despite the damage that has already been done, new studies have been and will continue to be done, hopefully deterring doctors and pharmaceutical companies from prescribing narcotic pain relievers without exploring other options first. It’s a long road to recovery for America and its opioid-dependent citizens, but progress is being made all the time.