Back and Neck Pain

Early Socioeconomic Causes of the Opiate Epidemic, Part II

Author| Barry Kerzin, MD

From the Dalai Lama's personal physician

Early Socioeconomic Causes of the Opiate Epidemic

In 1980, Dr. Hershel Jick at Boston University’s School of Medicine wrote a five-sentence Letter to the Editor that was published in the prestigious New England Journal of Medicine. In 100 words, Jick wrote that in about 12,000 hospitalized patients treated with narcotics, there had been only four cases of addiction. So, Jick concluded, the risk of dependency was rare [5].

Dr. Juurlink and his colleagues from Canada recently analyzed the extent of the spread of Jick’s letter.  They found 608 examples of citations, the majority of them uncritical, with a sizable increase in citations after the 1995 introduction of the most notorious prescription opioid OxyContin. And some authors “grossly misrepresented” the conclusions of the letter, as in a 2006 paper that used Jink’s letter to the editor to assert: “The medical evidence overwhelmingly indicates that properly administered opioid therapy rarely if ever results in ‘accidental addiction’ or ‘opioid abuse.’”

The Canadian study found that Jick’s letter to the editor was cited 608 times — 60-fold more often than other letters published the same year in the New England Journal of Medicine. The article was also cited by a 1995 editorial in the journal Canadian Family Physician — distributed to most family doctors in the country. The journal found the one-paragraph study’s conclusions “persuasive,” giving evidence that patients can take opioids over the long term without getting addicted. “We believe that this citation pattern contributed to the North American opioid crisis by helping to shape a narrative that allayed prescribers’ concerns about the risk of addiction associated with long-term opioid therapy,” Juurlink and his colleagues concluded. Better research has since suggested that five to 10 percent of people prescribed opioid painkillers for chronic pain get addicted, a “staggering” number given the millions taking them, said Juurlink [6].

5. Jick, H (1980) Addiction Rare in Patients Treated with Narlitics. NEJM Vol 302: No. 2

Continue to Part III