Misleading science: How a 1980 publication led to US opioid crisis

Not all of science is built on the shoulders of giants.

Sometimes science stumbles when it is based on political agendas, on fake science, on exaggerations and even – in this case – on mistaken conclusions.

Eventually science gets corrected, but much damage can be done till then.

In January 1980, the New England Journal of Medicine published this letter from scientists at the Boston University Medical Center (Vol 302, No 2).

This “letter” has been cited extensively in justifying the use of opioids and in the assumption that this would be non-addictive.

Now the same journal has published a new study (Vol 376, June 2017) which traces the current opioid crisis to this letter which has been “heavily and uncritically cited as evidence that addiction was rare with long-term opioid therapy”.

Leung et al, A 1980 Letter on the Risk of Opioid Addiction, N Engl J Med 2017; 376:2194-2195, June 1, 2017, DOI: 10.1056/NEJMc1700150

The prescribing of strong opioids such as oxycodone has increased dramatically in the United States and Canada over the past two decades.1 From 1999 through 2015, more than 183,000 deaths from prescription opioids were reported in the United States,2 and millions of Americans are now addicted to opioids. The crisis arose in part because physicians were told that the risk of addiction was low when opioids were prescribed for chronic pain. A one-paragraph letter that was published in the Journal in 19803 was widely invoked in support of this claim, even though no evidence was provided by the correspondents (see Section 1 in the Supplementary Appendix, available with the full text of this letter at NEJM.org).

We performed a bibliometric analysis of this correspondence from its publication until March 30, 2017.  …….. 

In conclusion, 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.

Without skepticism there is no science.



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