Nearly 40 years ago, a respected doctor wrote a letter to the New England Journal of Medicine with good news: Out of nearly 40,000 patients given powerful pain drugs, only four addictions were documented. Doctors had been wary of opioids, but reassured by the letter, which called addiction "rare" in those with no history of addiction, they spread the good news in their own published reports. And that's how a one-paragraph letter with no supporting information helped seed a nationwide epidemic of misuse of drugs like Vicodin and OxyContin, the AP reports. On Wednesday, the journal published an editor's note about the 1980 letter and analysis from Canadian researchers of how often it has been cited—more than 600 times, often inaccurately. Most used it as evidence that addiction was rare and didn't say it only concerned hospitalized patients, not outpatient or chronic pain situations.
"It's difficult to overstate the role of this letter," says the University of Toronto's Dr. David Juurlink, who led the analysis. Hospital databases were so limited in 1980 that there could have been more problems, or cases discovered after patients were discharged, he adds. The letter was written by Dr. Hershel Jick, a drug specialist at Boston University Medical Center, and a grad student. "I'm essentially mortified that that letter to the editor was used as an excuse to do what these drug companies did," Jick says. He also notes he testified as a government witness in a lawsuit years ago over the marketing of pain drugs. The new editor's note says: "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." The journal also published a report pledging to develop new ways to reverse and prevent overdoses, treat addiction, and find novel, non-addictive drugs for chronic pain.