Innocuous start to opioid addition: A 1980 letter that started it all

By Dr. Ananya Mandal, MDJun 1 2017

In a letter to the Editor published this Wednesday (31st May 2017), a group of Canadian researchers have disclosed how a sting of words coming from a notable doctor nearly 4 decades ago was the seed that led to a nationwide epidemic of misuse and abuse of opioid painkiller drugs such as Vicodin and OxyContin.

The letter in 1980 was cited by over 600 researchers in various works of science and this was grossly inaccurate. The paper inadvertently made it seem like opioids were safer that they were initially thought to be. This convinced thousands of doctors into prescribing these drugs to patients in pain leading to opioid addition that has become a menace today.

While one citation from the 1980 paper suggests that in a population with pain and with no previous history of drug abuse, there is “literally” “no risk for addiction”. One citation suggested that “addiction rarely evolves in the setting of painful conditions”. Opioids were thought to be safer than they are and were widely used in hospitalized patients and not just in chronic pain patients such as those with arthritis.

This new study was led by Dr. David Juurlink of the University of Toronto. He feels that this 1980 letter was a “key bit of literature” that convinced opiate manufacturers who in turn gladly coaxed prescribers that addiction was nothing to fear and could be taken as low risk affair. He added that in 1980’s the hospital databases were not adequately robust in order to support such a claim.

The 1980 letter was written by Dr. Hershel Jick who was a drug specialist at Boston University Medical Center and that the time a graduate student. Jick’s intention was not to perpetuate the use of these highly addictive drugs but opiate manufacturers used those words to advance their claims and meet their ends. Jick was referring to the short period use of opiates in the hospital and was not suggesting long term use. He went on to testify as a government witness in a lawsuit over the marketing of these pain relieving drugs. It was in the 90’s that drugs like OxyContin came into the market and many patients took it for chronic pain and went on to develop drug dependence and addiction.

The editor in their note in the journal say that readers need to be aware how the letter was “heavily and uncritically cited” to show that opioid addiction is a rare occurrence. The journal went on to publish a report from Dr. Francis Collins, director of the National Institutes of Health, and Dr. Nora Volkow, head of the National Institute on Drug Abuse. This report suggests that the researchers would in future work along with the industry in more ethical ways to develop methods to reverse and prevent overdose of these drugs and also prevent addition. They suggest new avenues of research in order to find new, non-addictive and effective drugs for chronic pain.

Three workshops are planned in the next couple of months by the NIH with drug company leaders to decide upon necessary steps to stop and restrict this menace of opioid addiction.