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U.S. NEWS Thursday 1 June 2017

American Living:

Painful words: How a 1980 letter fueled the opioid epidemic

By MARILYNN MARCHIONE ing that addiction rarely Dr. Hershel Jick, a drug lawsuit years ago over the a hospital setting. We know
AP Chief Medical Writer evolves in the setting of specialist at Boston Univer- marketing of pain drugs. that not to be true.”
Nearly 40 years ago, a re- painful conditions,” said sity Medical Center, and a Use grew in the 1990s when The journal also published a
spected doctor wrote a another. graduate student. drugs like OxyContin came report from Dr. Francis Col-
letter to the New England lins, director of the National
Journal of Medicine with Institutes of Health, and Dr.
some very good news: Out Nora Volkow, head of the
of nearly 40,000 patients National Institute on Drug
given powerful pain drugs Abuse, pledging to work
in a Boston hospital, only with industry to develop
four addictions were docu- new ways to reverse and
mented. prevent overdoses, to treat
Doctors had been wary of addiction, and to find nov-
opioids, fearing patients el, non-addictive drugs for
would get hooked. Reas- chronic pain.
sured by the letter, which In the next six weeks, NIH
called this “rare” in those will hold three workshops
with no history of addiction, with drug company leaders
they pulled out their pre- to identify next steps, Col-
scription pads and spread lins said. The goal is to cut
the good news in their own in half the usual amount of
published reports. time to develop new treat-
And that is how a one- ments — a target borrowed
paragraph letter with no from the Cancer Moonshot
supporting information project launched by former
helped seed a nationwide Vice President Joe Biden to
epidemic of misuse of drugs make a decade’s worth of
like Vicodin and OxyContin progress toward cures in
by convincing doctors that half that time.
opioids were safer than we A pharmacy tech poses for a picture with hydrocodone bitartrate and acetaminophen tablets, Details have not been
the generic version of Vicodin in Edmond, Okla. A report released Wednesday, May 31, 2017
now know them to be. traces how a short letter in a medical journal in 1980 helped sow the seeds of today’s opioid worked out, but it could re-
On Wednesday, the journal epidemic by helping to convince doctors that these powerful painkillers carried less risk of ad- semble similar partnerships
published an editor’s note diction than they actually do. on Alzheimer’s, diabetes
about the 1980 letter and (AP Photo/Sue Ogrocki) and some other diseases
an analysis from Canadian where scientists from gov-
researchers of how often “It’s difficult to overstate “I’m essentially mortified on the market, and more ernment and industry de-
it has been cited — more the role of this letter,” said that that letter to the editor people using opioids for termine pressing needs, de-
than 600 times, often inac- Dr. David Juurlink of the Uni- was used as an excuse to chronic pain developed velop a work plan and split
curately. Most used it as versity of Toronto, who led do what these drug com- dependence . the cost, Collins said.
evidence that addiction the analysis. “It was the key panies did,” Jick told The The new editor’s note in the “Industry’s interest in this has
was rare, and most did not bit of literature that helped Associated Press in an inter- journal says: “For reasons been muted until recently,”
say it only concerned hos- the opiate manufacturers view on Wednesday. “They of public health, readers Collins said. Now, “they feel
pitalized patients, not out- convince front-line doctors used this letter to spread should be aware that this the responsibility and the
patient or chronic pain situ- that addiction is not a con- the word that these drugs letter has been ‘heavily opportunity to take part in
ations such as bad backs cern.” were not very addictive.” and uncritically cited’ as this and they’re not going
and severe arthritis that Hospital databases were Jick said his letter only re- evidence that addiction is to stand back and watch.”
opioids came to be used so limited in 1980 that we ferred to people getting rare with opioid therapy.” With the Food and Drug
for. can’t be confident there opioids in the hospital for The journal’s top editor, Dr. Administration wanting to
“This pain population with weren’t more problems, a short period of time and Jeffrey Drazen, said, “Peo- speed work on new pain
no abuse history is literally or cases discovered after has no bearing on long- ple have used the letter drugs, “the stars are align-
at no risk for addiction,” patients were discharged, term outpatient use. He to suggest that you’re not ing,” Collins said. “I think
one citation said. “There Juurlink said. also said he testified as a going to get addicted to we can make real progress
have been studies suggest- The letter was written by government witness in a opioids if you get them in now.”q