A paragraph in a letter published in 1980 in the New England Journal of Medicine may have had a huge impact on the opioid crisis in the United States.

The 101-word letter to the editor, titled “Addiction Rare in Patients Treated with Narcotics,” was written by Jane Porter and Dr. Hershel Jick of Boston University. The cited paragraph claimed that out of their 11,000-plus patients treated with narcotics, there were only four cases of addiction.

Image credit: Vox
Image credit: Vox

Porter and Jick’s letter has been quoted multiple times to claim that narcotics aren’t highly addictive

The letter has been quoted by many researchers in studies and journals since its publication. However, a new letter published in the New England Journal of Medicine analyzed the citations and its context.

The analysis was conducted by researchers at the Institute for Clinical Evaluative Sciences, in an effort to assess how frequently other researchers have cited Porter and Jick’s letter. They found 608 citations of the initial letter as of May 30, and that 72 percent of them used it as proof that addiction was rare among long-term narcotic users.

“Five-sentence letter to the editor in medicine’s most prestigious journal was leveraged as proof that opioids could be used safely over the long term, even though it offered no evidence to support that claim,” said Dr. David Juurlink, one of the researchers involved in the analysis, according to CNN. “It’s clear that many of the authors who cited it hadn’t actually read it.”

Statistics show that 91 Americans die from an opioid overdose every day. Drug overdoses have become the leading cause of accidental deaths in the U.S., and it kills more people than guns or car accidents. The opioid crisis has become a major problem, and although Americans represent only around 5 percent of the global population, they consume around 80 percent of the world’s opioid painkillers.

The letter’s mentions rose in 1995 following the introduction of the highly addictive OxyContin

Jick told CNN last year that his 1980 letter has been misrepresented, that he never intended to speak about the general population, but rather referred only to patients monitored in a hospital setting. However, according to the new analysis, over 80 percent of the articles that cited the letter made no mention of the fact that these were hospitalized patients.

Furthermore, most of the mentions weren’t critical at all of the letter or the idea that these narcotics could be dangerous to prescribe long-term. The letter even began being more cited after the 1995 introduction of OxyContin, the long-acting formulation of oxycodone. Although positive references of the letter have decreased in the past few years, they remained as of 2016. The researchers didn’t find any mention of the letter on a study or report published this year.

Public health experts, legislators and law enforcement are trying to address the opioid crisis, as it continues to worsen and claim American lives. Among the most recent efforts, the Ohio Attorney General, Mike DeWine, filed a suit this week against five pharmaceutical companies: Purdue Pharma -the maker of OxyContin-, Teva Pharmaceuticals, Allergan, Endo Health Solutions and Janssen, which is a subsidiary of Johnson & Johnson.

“These drug manufacturers led prescribers to believe that opioids were not addictive, that addiction was an easy thing to overcome, or that addiction could actually be treated by taking even more opioids,” said DeWine in a statement, according to CNN.

Ohio now joins a growing list of states and municipalities, like Mississippi and Chicago, claiming that pharmaceuticals recklessly pushed the prescribing of addictive drugs while knowing the risks.

The Heroin and Opioid Prevention Effort and Treatment Act went into effect this Wednesday in Maryland, effectively making naloxone available over the counter. Naxolone is a medication that can reverse opioid overdose.

Source: CNN