Near 200,000 People have died by overdosing on prescription painkillers, and a brand new report traces among the blame to 5 easy sentences written practically 40 years in the past.
The sentences, containing simply 101 phrases, appeared in a 1980 problem of the New England Journal of Medication. They fashioned a letter to the editor that described a rudimentary evaluation of 11,822 hospital sufferers who took a narcotic painkiller at the very least as soon as. The overwhelming majority of these sufferers tolerated the medicine with out incident, in accordance with Jane Porter and Dr. Hershel Jick of the Boston Collaborative Drug Surveillance Program.
“There have been solely 4 circumstances of moderately nicely documented dependancy in sufferers who had no historical past of dependancy,” Porter and Jick reported. “The dependancy was thought of main in just one occasion.”
Of their view, the takeaway was clear: “We conclude that regardless of widespread use of narcotic medicine in hospitals, the event of dependancy is uncommon in medical sufferers with no historical past of dependancy.”
That conclusion turned out to be mistaken.
Between 1999 and 2015, tens of millions of People turned hooked on opioid painkillers and greater than 183,000 died on account of taking the prescribed drugs. Based on the Facilities for Illness Management and Prevention, as much as 25% of sufferers who get an opioid prescription to deal with noncancer ache wind up scuffling with dependancy.
“The disaster arose partially as a result of physicians have been instructed that the danger of dependancy was low when opioids have been prescribed for persistent ache,” in accordance with the authors of a brand new letter to the editors of the New England Journal of Medication. The 1980 letter was “extensively invoked in help of this declare,” regardless that the 5 sentences contained just about “no proof” to again it up.
The authors of the 2017 letter — led by Pamela T.M. Leung of the College of Toronto — carried out a bibliometric evaluation to find out what number of instances the 1980 letter was cited by different students. The reply: 608 instances up by way of March 30, 2017.
If that quantity strikes you as excessive, that’s as a result of it's. Leung and her colleagues additionally counted the citations for 11 different letters to the editor that have been printed inside 4 weeks of Porter and Jick’s letter. The median variety of citations for these different letters was 11.
Nevertheless it’s not simply the sheer variety of instances the 1980 letter was cited as proof that prescription painkillers aren’t addictive, Leung and her colleagues wrote. It’s the uncritical — typically deceptive — approach wherein its declare has been repeated.
For example, among the many 608 papers that cited the unique letter, 81% failed to say that the sufferers behind the 4-in-11,882 statistic have been being handled in a hospital. Their expertise wouldn’t essentially translate to outpatients who weren't underneath the watchful eyes of medical doctors and nurses.
A number of the stories that cited the 1980 letter did so quite sloppily. One of many extra egregious examples appeared in a 1994 problem of Seminars in Oncology.
“The Boston Drug Surveillance Program reviewed the charts of practically 12,000 most cancers ache sufferers handled over a decade and located solely 4 of them might be labeled as addicts,” wrote Dr. Michael H. Levy, who lately retired as director of the Ache and Palliative Care Program at Fox Chase Most cancers Heart in Philadelphia. In truth, Porter and Jick made no point out of what ailed the sufferers of their pattern.
That was hardly the one case of careless attribution. Among the many others that stood out to Leung and her colleagues was this 2002 gem from the Worldwide Journal of Medical Follow:
“Worry of dependancy could result in reluctance by the doctor to prescribe,” wrote Dr. Sian Iles, an affiliate professor of radiology at Dalhousie College in Halifax, Nova Scotia, and colleagues. “Nevertheless, there isn't any proof that this happens when prescribing opioids for ache.”
Nancy Kowal, a nurse practitioner on the College of Massachusetts Memorial Medical Heart in Worcester, went even additional in a 1999 report in Nursing Economics.
“This ache inhabitants with no abuse historical past is actually at no danger for dependancy,” Kowal wrote.
Leung and her colleagues famous a rise in citations of the 1980 letter after OxyContin got here in the marketplace within the mid-Nineteen Nineties. Bought by Purdue Pharma, it was a brand new formulation of the opioid oxycodone that promised to alleviate ache for 12 hours. If medical doctors have been involved concerning the dependancy dangers this introduced, right here was a report in an esteemed medical journal that would put their minds comfy.
The legislation ultimately caught up with Purdue Pharma and three of its high executives. In 2007, they pleaded responsible to felony prices of deceptive regulators, medical doctors and sufferers about OxyContin’s addictive qualities.
“Purdue accepted duty for the actions a few of its workers took previous to 2002, and since that point we have now led the business in growing abuse-deterrent know-how, advocating for the usage of prescription drug monitoring packages and supporting entry to Naloxone — all essential parts for combating the opioid disaster,” the corporate stated in a press release.
But the 1980 letter continues to be cited within the medical literature as proof that opioid painkillers pose little or no danger to sufferers.
The liberal reliance on these 5 sentences helped “form a story that allayed prescribers’ issues concerning the danger of dependancy related to long-term opioid remedy,” Leung and her colleagues concluded.
Practically 2 million People are nonetheless scuffling with the implications.
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UPDATES:
3:35 p.m.: This story has been up to date to incorporate a remark from Purdue Pharma, the corporate that makes OxyContin.
This story was initially printed at 2 p.m.
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