Origins of Opioid Epidemic Linked to Weak Evidence

opioid_1200.jpgWith the recent and controversial proposed changes to the American healthcare system looming large, one narrative has been at the forefront: how will these changes affect the battle being waged against the opioid addiction epidemic?

The statistics surrounding the widespread damage caused by opioid abuse and addiction are staggering. According to the American Society of Addiction Medicine (ASAM):

  • “Of the 20.5 million Americans 12 or older that had a substance use disorder in 2015, 2 million had a substance use disorder involving prescription pain relievers and 591,000 had a substance use disorder involving heroin.”
  • “Drug overdose is the leading cause of accidental death in the US, with 52,404 lethal drug overdoses in 2015. Opioid addiction is driving this epidemic, with 20,101 overdose deaths related to prescription pain relievers, and 12,990 overdose deaths related to heroin in 2015.”
  • “From 1999 to 2008, overdose death rates, sales and substance use disorder treatment admissions related to prescription pain relievers increased in parallel.”
  • “The overdose death rate in 2008 was nearly four times the 1999 rate; sales of prescription pain relievers in 2010 were four times those in 1999; and the substance use disorder treatment admission rate in 2009 was six times the 1999 rate.”
  • “In 2012, 259 million prescriptions were written for opioids, which is more than enough to give every American adult their own bottle of pills.”

Last week, a newly published letter in the New England Journal of Medicine (NEJM) concluded that a 1980 letter, published in the same journal, had a heavy influence on the birth of the epidemic.

The letter, dated January 10, 1980, concerned a retrospective chart review of patient files conducted to determine how often hospitalized patients became addicted to their narcotic pain medications. Of 39,946 patients reviewed, 11,882 received at least 1 narcotic during their hospital stay; just 4 of these patients developed a new narcotic addiction. The letter concluded that, “despite widespread use of narcotic drugs in hospitals, the development of addiction is rare in medical patients with no history of addiction.”

pain meds_1200.jpg“The authors of this new letter conclude that the 1980 letter was ‘heavily and uncritically cited as evidence that addiction was rare with long-term opioid therapy.’ They further conclude that the 1980 letter helped to propel the current opioid crisis in North America.”

Last week, the NEJM added an unusual editorial comment above the 1980 letter to warn readers that the letter has been inaccurately cited and heavily misquoted over the intervening decades. The merits of the letter are not challenged. The issue is how the letter has been used to support an erroneous claim. The editorial comment contains a link to a newly published letter in NEJM from a group of Canadian physicians that describes the impact of the 1980 letter. The authors of this new letter conclude that the 1980 letter was “heavily and uncritically cited as evidence that addiction was rare with long-term opioid therapy.” They further conclude that the 1980 letter helped to propel the current opioid crisis in North America.

There are few better examples of the need for solid evidence in driving clinical practice decisions. Unbiased assessments of the peer-reviewed, published literature, performed with scientific rigor, are absolutely crucial to providing care that is both safe and effective.

We reported on this letter in our News Service, a value-added feature of the Hayes evidence solution. Schedule a demo today to see how our health technology assessments can help you deliver the best possible evidence-based medicine.

Topics: Hayes Blog

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