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How a Letter to an Editor Written in 1980 Fueled Prescription Opioid Crisis in US

A 1980 letter, published in the New England Journal of Medicine, is believed to have given wings to the current prescription opioid crisis in America. The letter summarized the study conducted to determine the risks of narcotic addiction. The researchers examined 39,946 patients, of whom 11,882 were subjected to a brief narcotic intervention. It was observed that there were only four cases wherein patients with no prior history had developed addiction.

The drugs in question were meperidine, Percodan, and hydromorphone. Authors Jane Porter and Hershel Jick from Boston Collaborative Drug Surveillance Program of Boston University Medical Center, said, “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.”

Unfortunately, the entire purpose of the study was taken out of context and was used to fuel the myth that opioids are safe without any risk of addiction. Pharmaceutical companies and drug makers have cited the content of the letter numerous times (a recent study indicates that it has been cited more than 600 times) to market their products. Some have even gone to the extent of pointing out that opioids are perfectly safe in outpatient settings, a point that has been countered by one of the authors.

In a note to the Associated Press, Jick explained that since the study was conducted in hospital settings and looked only at patients who had received opioids for short duration therefore, it “has no bearing on long-term outpatient use.”

Pain used as excuse to prescribe opioids

More than 52,000 drug overdosing mortalities were reported in 2015 with 63 percent deaths attributed to opioids. Overdosing proved to be more fatal than automobile accidents (more than 38,000 mortalities) and gun violence (36,000 mortalities) during the year. The 2015 numbers even surpassed the mortality rates when the dreaded HIV/AIDS was at its peak and 43,000 people reportedly lost their lives to it. The Centers for Disease Control and Prevention (CDC) estimates that 91 Americans succumb to opioid overdose every day.

Pharmaceutical companies have taken it upon themselves to promote drugs such as OxyContin and Percocet for chronic pain despite suggestions by researchers that opioid painkillers aren’t fully effective and have serious side effects. It is also interesting to note that ever since Purdue Pharma introduced OxyContin in the 1990s, there has been a surge in the way prescription drugs have been doled out. As more Americans suffer from pain, these companies have tapped the opportunity to persuade health care professionals to prescribe more opioids. As a result, many physicians end up overprescribing and risking their patients’ lives.

Mortified by how the pharmaceutical companies unscrupulously used the content of the letter to serve their own ends, Jick said, “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.”

Controlling prescription drug misuse

Pain is a relative concept and it is open to interpretation. In the absence of any biological measure, physicians prescribe medication based on what they deem fit and how an individual responds to questions. Even if opioids are prescribed to treat pain, doctors should closely monitor the doses, trace the patient’s history of drug use and inform them about harmful effects of long-term use. Leftover opioids at home should be discarded before they get into the hands of a child and causes mayhem. Self-medication through prescription drugs should be strictly avoided as it may lead to physical and mental health complications.

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