The Paragraph That Helped Kick Off The Opioid Crisis

The reasons behind America’s ongoing opioid crisis are legion — from a sputtering economy in the rural parts of the country triggered by the Great Recession to pharmaceutical companies burying their own data on how short-lasting their prescription drugs actually were.

But one of the most influential culprits, a new report published Thursday in the New England Journal of Medicine has concluded, is a five sentence piece of research the journal itself had published in 1980. For years, these few lines were constantly cited beyond their original intent, helping to soothe doctors’ fears about addiction risk and to justify pharmaceutical companies’ aggressive drug marketing.

In the journal’s January 1980 issue, drug specialist Hershel Jick, along with a graduate student, penned a short research letter. They had looked through the medical records of nearly 40,000 patients at their hospital, the Boston University Medical Center, and found that out of some 11,000 who were taking narcotic painkillers, only four had seemingly developed any kind of addiction, and only one person’s addiction was considered major. “Despite widespread use of narcotics in hospitals,” they wrote, “the development of addiction is rare in medical patients with no history of addiction.”

Jick’s assertion was never backed up by any evidence, since research letters are the scientific equivalent of telling your friends an interesting story at happy hour. Even if it was a fully-fledged, peer-reviewed study, it was only meant to describe hospital patients who used opioids for a brief time, not the sort of long-term at-home users who often become addicted today.

In the decades after its publication, the paragraph was cited by other researchers more than 600 times, particularly after supposedly safer and longer-lasting opioids like OxyContin became available to the public in the mid 1990’s (claims revealed later to be often untrue).

Authors of the article published on Thursday found that 3 of 4 studies that cited Jick’s research used it as proof that addiction could almost never happen, no matter what the circumstances.

“This pain population with no abuse history is literally at no risk for addiction,” one 1996 study claimed. Other doctors, including those funded by drug manufacturers, used it to goad their colleagues into abandoning their worries of over-prescribing opioids.

“I’m essentially mortified that that letter to the editor was used as an excuse to do what these drug companies did,” Jick told The Associated Press. “They used this letter to spread the word that these drugs were not very addictive.”

The silver lining, if there is any, is that Jick’s letter has started to fade out of relevance, with fewer positive citations every year. But though a decade ago, the makers of OxyContin, Purdue Pharma, pled guilty in federal court to having misled the public and regulators about how addictive their drug was, the crisis today remains at its peak, with millions of Americans addicted to both prescription and street narcotics. And despite a new editor’s note affixed to Jick’s letter, it’s certain we’ll be dealing with the fallout for years more to come.