How a 101-word letter in an academic journal helped fuel the opioid epidemic

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A one-paragraph letter to the editor published in a 1980 issue of the New England Journal of Medicine may have played a much larger role in contributing to the opioid epidemic than researchers previously believed, according to a recent report cited by The Los Angeles Times.

The 101-word, five-sentence letter to the editor published in 1980 discussed a study conducted by researchers from the Boston University School of Public Health Boston Collaborative Drug Surveillance Program.

For the study, researchers examined 11,822 hospital patients who were given narcotic pain killers at least once. Out of the 11,822 patients, "there were only four cases of reasonably well documented addiction in patients who had no history of addiction." Researchers concluded that "despite widespread use of narcotic drugs in hospitals, the development of addiction is rare in medical patients with no history of addiction."

In a new 2017 letter to the editor published in the NEJM, researchers argued the opioid epidemic was caused, in part, because physicians "were told that the risk of addiction was low when opioids were prescribed for chronic pain" — a belief that largely rested on information presented in the 1980 letter, despite the fact that the letter contained "no evidence" to back up the conclusion, researchers claimed, according to the report.

Authors of the 2017 letter conducted a bibliometric analysis and discovered the 1980 letter was cited roughly 608 times since its publication in 1980 through March 30, 2017. Researchers also discovered that, in addition to being cited so frequently, the information in the letter was often referenced incorrectly or presented in a misleading fashion. Among the 608 papers that cited the original letter, the majority (81 percent) failed to mention that the 11,882 patients involved in the study were treated in a hospital inpatient setting, meaning their experience — and ultimately the authors' finings — may not translate to an outpatient setting, according to the report.

Researchers also reportedly saw an increase in the number of citations after the release of OxyContin into the market during the mid-1990s.

The continued reliance and citation of such medical literature helped "shape a narrative that allayed prescribers' concerns about the risk of addiction associated with long-term opioid therapy," the authors of the 2017 letter concluded.

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