Limited evidence, faulty reasoning, and potential for a global opioid crisis

Human susceptibility to faulty reasoning and cognitive bias has undoubtedly contributed to the US opioid crisis. The New England Journal of Medicine (NEJM) recently published an analysis by Leung and colleagues documenting the blunder that resulted from a brief NEJM letter published in 1980.1 The letter reported a low rate of “addiction” among 39 946 hospital inpatients, roughly one third of whom were prescribed “narcotics.” This flawed letter of just five sentences has been cited 608 times since publication. Most citations use the letter as evidence that addiction is rare in patients prescribed opioids. NEJM has taken the unprecedented move for reasons of public health to issue an Editor’s note on the original correspondence indicating that it has been “heavily and uncritically” cited.

Did the letter contribute to the current US opioid public health crisis? Although it is unlikely that the letter, in isolation, had a profound effect on clinical care, its use is emblematic of the ways in which drug companies and others influenced …