All posts by Monica Bell

Opioid Epidemic

NPR: Sloppy Citations of 1980 Letter Led to Opioid Epidemic

Doctor Who Wrote 1980 Letter On Painkillers Regrets That It Fed The Opioid Crisis

June 16, 201712:22 PM ET
Heard on Morning Edition
 
A 1980 letter published in the New England Journal of Medicine was later widely cited as evidence that long-term use of opioid painkillers such as oxycodone was safe, even though the letter did not back up that claim.
 
A one-paragraph letter, barely a hundred words long, unwittingly became a major contributor to today’s opioid crisis, researchers say.

“This has recently been a matter of a lot of angst for me,” Dr. Hershel Jick, co-author of that letter, told Morning Edition host David Greene recently. “We have published nearly 400 papers on drug safety, but never before have we had one that got into such a bizarre and unhealthy situation.”

The letter, published in the New England Journal of Medicine in 1980, was headlined “Addiction Rare in Patients Treated With Narcotics.” Written by Jick and his assistant Jane Porter of the Boston Collaborative Drug Surveillance Program at Boston University Medical Center, it described their analysis of hospitalized patients who had received at least one dose of a narcotic painkiller. Among the nearly 12,000 patients they looked at, they found “only four cases of reasonably well documented addiction in patients who had no history of addiction.” Their conclusion was that despite widespread use of narcotics in hospitals, addiction was rare in patients who had no history of addiction.

Inaccurate representations of that 1980 letter led to a dramatic increase in the prescribing of opioids for chronic pain, according to an article published this month in the same medical journal by Dr. David Juurlink of the University of Toronto, who researches drug safety. He and his co-authors found more than 600 citations of the letter, a majority of which failed to note that the patients whom Jick and Porter described were in hospitals for brief stays when prescribed opioids. Some of the citations “grossly misrepresented the conclusions of the letter,” they found.

“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,” they write, pointing out that citations soared after the introduction of OxyContin in the mid-1990s.

Jick says that when the letter was published in 1980, it was almost inconsequential. “Only years and years later, that letter was used to advertise by new companies that were pushing out new pain drugs,” he says. “I was sort of amazed. None of the companies came to me to talk to me about the letter, or the use as an ad.”

He says the drug companies used his letter to conclude that their new opioids were not addictive. “But that’s not in any shape or form what we suggested in our letter.”

Asked whether he regrets having written the letter, Jick says, “The answer is, fundamentally, sure. The letter wasn’t of value to health and medicine in and of itself. So if I could take it back — if I knew then what I know now, I would never have published it. It wasn’t worth it.”

Photo credit: ThomasWalker via Foter.com / CC BY-NC

Employer Retaliation

NPR: An ICE Arrest After A Workers’ Comp Meeting Has Lawyers Questioning If It Was Retaliation

 

As if there aren’t enough reasons to not report an on the job injury. Now an undocumented employee can risk their employer turning them in to Immigration and Customs Enforcement (ICE) for possible deportation. How deportation will effect the claim is still unknown. The following story was published by National Public Radio on May 17, 2017.

Thirty-seven-year-old Jose Flores and his longtime partner, Rosa Benitez, have been living in Massachusetts for almost seven years. The Honduran nationals both entered the United States by illegally crossing the Southern border.

Benitez, 40 and with tired eyes, says she and Flores had to leave Honduras because of the violence.

‘I Came Here To Fight For My Family’

“Like all of the immigrants arriving from other countries,” she said in Spanish, “I came here to fight for my family. That’s why I’m here. Honduras is terrorized by gangs. I can’t live there. My dad was killed by the gangs. They threatened him and told him to pay a fee, but he didn’t pay it.”

The couple has five children together, three of whom are U.S.-born citizens. The oldest is 17 and the youngest is 2 years old. Benitez says since Flores was arrested by federal immigration agents last week, all of the children are scared and asking when their dad is coming home.

The family has had no income for two months. Flores, the sole provider, hasn’t been able to work since the end of March when he fell off a ladder at a job site, breaking his femur bone in his leg and undergoing several subsequent surgeries. After consulting with attorneys, and even though he’s living here illegally, Flores sought compensation from the Boston-based construction company he was working for.

Stacie Sobosik is a workers’ compensation attorney who’s advising Flores, and she says he’s within his rights.

“Under case law in Massachusetts, undocumented workers are eligible for the same benefits as any other worker injured in the state,” she said.

Sobosik says she works with plenty of clients who are in the country without documentation and often they’re hesitant to report workplace accidents. The fear is that doing so will result in retaliation from employers in the form of a call to Immigration and Customs Enforcement (ICE).

“And we’ve always been able to tell clients,” Sobosik said, “ICE has better things to do, bigger fish to fry, than to come after an injured worker because their boss has reported them.”

But that’s exactly what Sobosik believes happened to Flores.

Fears Bosses Could Retaliate Against Some Immigrant Workers

Sobosik says she could not have expected what would take place when Flores’ boss offered some cash to help the family and arranged a meeting.

“The employer told this worker where to be, at exactly what time, and immigration was waiting,” Sobosik explained.

Lawyers for Flores say it’s still unclear whether the employer — who, it turns out, had no workers’ comp coverage on the day of Flores’ accident — arranged the arrest that day.

>>For photos and to read the rest of the NPR story, click here.

Photo credit: Max Nathan via Foter.com / CC BY-NC-ND