How A 5-Sentence NEJM Letter Caused the Opioid Epidemic

July 28, 2017

5 Sentences = Opioid Epidemic
In 1980, two authors wrote a 5-sentence letter to the editor of the NEJM about their experience with hospitalized patients who needed pain medicine at some point during their stay.  They found that in nearly 12,000 patients, only 4 went on to become addicted to pain medicine.  The letter to the NEJM editor we are covering today points out that the original 5-sentence letter has now been cited over 600 times, mostly to support more liberal use of opiates in the outpatient setting.  Citations skyrocketed after the introduction of OxyContin in 1995.  Uncritical and gross misrepresentation of this tiny letter has contributed to our current opioid epidemic by falsely reassuring doctors that opiates, even for legitimate pain, have little to no addiction potential.  We have learned since how very wrong that is.

Spoon Feed
A 5 sentence letter to the NEJM editor in 1980 has been cited over 600 times to support opiate prescribing, which was not even the point of the original letter.  We bought the line that opiates for legitimate pain were not addictive and didn’t consider the source.

Another Spoonful
This was all over the media.  The NPR Shots blog has a great post and audio.

Source
A 1980 Letter on the Risk of Opioid Addiction.  N Engl J Med. 2017 Jun 1;376(22):2194-2195. doi: 10.1056/NEJMc1700150.

Peer reviewed by Thomas Davis.