How A Five Sentence Doctor’s Note Helped Facilitate The Opioid Epidemic

All it took was one-hundred words to kill over hundreds of thousands of Americans. A new report from the New England Journal of Medicine tells the story of how this short doctor’s note helped facilitate today’s American opioid epidemic:

We found that a five-sentence letter published in the Journal in 1980 was heavily and uncritically cited as evidence that addiction was rare with long-term opioid therapy. We believe that this citation pattern contributed to the North American opioid crisis by helping to shape a narrative that allayed prescribers’ concerns about the risk of addiction associated with long-term opioid therapy. In 2007, the manufacturer of OxyContin and three senior executives pleaded guilty to federal criminal charges that they misled regulators, doctors, and patients about the risk of addiction associated with the drug. Our findings highlight the potential consequences of inaccurate citation and underscore the need for diligence when citing previously published studies.

Since opioids were not widely used forty years ago, so doctors did not have much data to support addictive properties. The New England Journal of Medicine performed a bibliometric analysis of the validity of the 1980 letter. There were 608 scholars that cited the letter as proof since 1980. 72% cited that addiction was rare among those prescribed opioids; however 81% of scholars did not mention that the patients were hospitalized when they receive the prescription. Because so many scholars cited the letter as a credible source, it became frequently used as a credible source for doctors diagnosing patients.

Opioids are safe when prescribed and utilized correctly and in moderation; however, they are not without addictive properties. Many prescription drugs carry opioids, so they are hard to avoid. Some symptoms of symptoms include: poor coordination, drowsiness, mood swings, depression, anxiety attacks, slurred speech and sleeping more or less. As many of these symptoms are hard to notice by others, and can happen sporadically to anyone, they are difficult to diagnose right away. Symptoms of opioid addiction include: constricted pupils, vomiting, loss of consciousness, and slow and erratic breathing and pulse.


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Deaths caused by opioids are now well documented. The United States and Canada has had a influx of opioid prescriptions since 1999. According to the National Center of Health Statistics, the number of deaths from prescription opioid pain relievers have increased from six thousand in 2001 to almost twenty-thousand in 2014. The drug has been taken by both men and women; however, the majority of deaths recorded have been women. Data from the Centers for Disease Control and Prevention stated that there have been more than 183,000 deaths from opioids prescribed were reported in the United States.

Make sure to learn more about opioids and its addictive properties from the U.S. Department of Health & Human Services. Read this article to learn more about how we can understand the opioid epidemic.

Read the full text of the letter below:


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Jed Belaguas

Jed Belaguas is endlessly curious about the ever-changing world of digital marketing. He graduated from the University of Pittsburgh with a Degree in Communications, and is well aware at how hard it is to make to and through medical school.