Opiates (1) Liberal prescription of opioids is based on a single research letter in NEJM 1980

12 December, 2022

Dear HIFA colleagues,

In 2023 we shall be exploring on HIFA the information needs of the public, health workers and policymakers on the prevention and management of addiction to opiates. This project is supported by The Annenberg Physician Training Program in Addiction Medicine at the Ulrich and Ruth Frank Foundation for International Health. To learn more about this organization, check out NextGenU.org, where you can access free courses on addiction, public health, medicine, and other health science topics. https://www.hifa.org/projects/mental-health-meeting-information-needs-su...

With this in mind I am sharing this message from the EVIDENCE-BASED-HEALTH discussion forum.

The message is from Dr Benjamin Djulbegovic MD (Professor of Medicine and Oncology at Moffitt Cancer Center, USF) and he writes:


"I hope everyone reads the short section on the Opiate crisis - the crisis, which resulted in thousands of unnecessary deaths (and is considered the key reason for the decline in life expectancy in the US- for the first time since 1900)

'Although the social tolls of the 'opioid crisis' have been devastating, a little-known fact is that the push to liberally prescribe opioids is based on a single research letter published in NEJM in 1980.[14] The letter stated: 'Recently, we examined our current files to determine the incidence of narcotic addiction in 39,946 hospitalized medical patients who were monitored consecutively. Although there were 11,882 patients who received at least one narcotic preparation, there were only four cases of reasonably well-documented addiction in patients who had no history of addiction.' This was used as evidence that the risk of addiction was low [14] prompting aggressive advertising for the liberal use of narcotics. (Note that evidence was based on hospitalized patients with no details about duration and dosage and extrapolated to ambulatory settings for the management of chronic pain.) In addition, to date reliable evidence on addiction potential and long-term effects of chronic use of opioids on social and functional status remains largely unknown and has only been very recently summarized.15 If such data were available, we argue that our former and current policies on how to avoid excessive use of opioids while helping manage severe pain would be more effective.'

Ref #14 we cite: Leung PTM, Macdonald EM, Stanbrook MB, Dhalla IA, Juurlink DN. A 1980 letter on the risk of opioid addiction. N Engl J Med. 2017;376(22):2194-2195"


COMMENT (NPW): In correspondence with Ben he tells me "I recently saw TV series - fictionalized but well researched story of the opioid crisis in the US - on Hulu called "Dopesick", which does appear to have the NEJM letter at the center of the Purdue pharma promotional efforts. I personally remain amazed that to this date we do not have reliable evidence of the opiate addiction potential, and particularly what happens to people when they take it chronically."

Best wishes, Neil

Neil Pakenham-Walsh, Global Coordinator HIFA, www.hifa.org neil@hifa.org

Global Healthcare Information Network: Working in official relations with WHO