"Addiction Rare in Patients Treated with Narcotics" is the title of a

letter to the editor A letter to the editor (LTE) is a Letter (message), letter sent to a publication about an issue of concern to the reader. Usually, such letters are intended for publication. In many publications, letters to the editor may be sent either through ...

written by Jane Porter and

Hershel Jick Hershel M. Jick (born December 1, 1931) is an American medical researcher and associate professor of medicine at Boston University School of Medicine, where he was formerly the director of the Boston Collaborative Drug Surveillance Program. Edu ...

and published in the January 10, 1980, issue of ''

The New England Journal of Medicine ''The New England Journal of Medicine'' (''NEJM'') is a weekly medical journal published by the Massachusetts Medical Society. It is among the most prestigious peer-reviewed medical journals as well as the oldest continuously published one. His ...

''. The letter analyzed data on patients who had been treated with

opioid Opioids are substances that act on opioid receptors to produce morphine-like effects. Medically they are primarily used for pain relief, including anesthesia. Other medical uses include suppression of diarrhea, replacement therapy for opioid us ...

s in a hospital setting, and concluded that addiction was uncommon among such patients. It has since been frequently misrepresented to claim that opioids are not addictive when prescribed for use at home, which has been blamed for contributing to the

opioid epidemic in the United States In the United States, the opioid epidemic (also known as the opioid crisis) is an extensive ongoing overuse of opioid medications, both from medical prescriptions and from illegal sources. The epidemic began in the United States in the late ...

Content

The letter reported on an examination of medical files of patients who had been hospitalized and treated with small doses of

s. The authors concluded that of the 11,882 patients who received at least one narcotic drug, only four of them had developed a "reasonably well documented" addiction among patients who had no history of addiction. Its text read, in its entirety:

Influence

The article was subsequently cited extensively as evidence that addiction was very rare among patients who were prescribed narcotics (more specifically, opioids). It became so well known that it is sometimes referred to simply as Porter and Jick.

Methodological limitations

Methodological limitations from which the letter suffered included that the patients it reported on were all given opioids in small doses in a hospital. Additionally, in 2003, Jick told ''

The New York Times ''The New York Times'' (''the Times'', ''NYT'', or the Gray Lady) is a daily newspaper based in New York City with a worldwide readership reported in 2020 to comprise a declining 840,000 paid print subscribers, and a growing 6 million paid ...

'' that the study did not follow patients after they left the hospital.

Misrepresentation

In 2017, the letter attracted renewed interest because the ''New England Journal of Medicine'' published a bibliographic analysis of the letter showing that it had been cited 608 times since it was published. In comparison, the other letters to the editor in the same issue of the ''Journal'' as Porter and Jick's letter had been cited a median of 11 times. Of these 608 citations, the analysis also showed that 72.2% of them cited it in support of the claim that patients treated with opioids rarely developed addiction, and 80.8% did not mention that the letter only included data on prescriptions given to hospitalized patients. It was also misrepresented in the popular media; a 1990 ''

Scientific American ''Scientific American'', informally abbreviated ''SciAm'' or sometimes ''SA'', is an American popular science magazine. Many famous scientists, including Albert Einstein and Nikola Tesla, have contributed articles to it. In print since 1845, it i ...

'' article described it as an "extensive study," and a 2001 ''

Time Time is the continued sequence of existence and events that occurs in an apparently irreversible succession from the past, through the present, into the future. It is a component quantity of various measurements used to sequence events, to ...

'' story dubbed it a "landmark study" showing that concerns about opioid addiction were "basically unwarranted." In addition,

Purdue Pharma Purdue Pharma L.P., formerly the Purdue Frederick Company, is an American privately held pharmaceutical company founded by John Purdue Gray. It was owned principally by members of the Sackler family as descendants of Mortimer and Raymond Sackl ...

, the manufacturer of

OxyContin Oxycodone, sold under various brand names such as Roxicodone and OxyContin (which is the extended release form), is a strong, semi-synthetic opioid used medically for treatment of moderate to severe pain. It is highly addictive and a commonly ...

, trained its sales representatives to say that the risk of addiction among patients using the drug was less than 1 percent, citing Porter and Jick's letter as one of their sources.

Role in the opioid epidemic

Because the letter has been frequently misrepresented to argue that opioids were rarely addictive, these misrepresentations have been blamed for contributing to the opioid epidemic. For example, a co-author of the 2017 bibliographic analysis, David Juurlink, has stated that he thinks the letter's appearance in a prestigious journal helped convince doctors that opioids were safe, saying, "I think it's fair to say that this letter went quite a long way." Jick, who wrote the letter, has since said that "The letter wasn't of value to health and medicine in and of itself. So if I could take it back—if I knew then what I know now, I would never have published it. It wasn't worth it."

References

External links

Original letter
{{portal bar, 1980s, Medicine Academic journal articles 1980 documents Pain management Opioids Letters (message) Clinical pharmacology Evidence-based medicine