Frequently Asked Questions

Opioids are a class of drugs that include the illegal drug fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and many others. These drugs are chemically related and interact with opioid receptors on nerve cells in the body and brain. Opioid pain relievers are generally safe when taken for a short time and as prescribed by a doctor, but because they produce euphoria in addition to pain relief, they can be misused (taken in a different way or in a larger quantity than prescribed, or taken without a doctor’s prescription). Regular use—even as prescribed by a doctor—can lead to dependence and, when misused, opioid pain relievers can lead to overdose incidents and deaths. An opioid overdose can be reversed with the drug naloxone when given right away. Improvements have been seen in some regions of the country in the form of decreasing availability of prescription opioid pain relievers and decreasing misuse among the Nation’s teens. However, since 2007, overdose deaths related to heroin have been increasing. Fortunately,  effective medications exist to treat opioid use disorders: methadone, buprenorphine, and naltrexone. These medications could help many people recover from opioid addiction

A tiny 100-word research article helped start the deadly opioid crisis, Canadian study shows

The one-paragraph research ‘letter’ in a major journal, claiming opioids hardly ever led to addiction, was cited an ‘unthinkable’ 608 times in other articles

A mother holds hydromorphone — a powerful opioid — prescribed to her daughter after surgery. A new Canadian study documents how a one-paragraph 1980 article helped de-stigmatize narcotics and fuel the opioid crisis.

The article is a single paragraph long, five sentences and 100 words, the bylines and pair of footnotes taking up almost as much space as the paper itself.

But there is new evidence that the curt research “letter” published in 1980 in one of the world’s most prominent medical journals has played a remarkable role in stoking North America’s deadly prescription-opioid crisis.

The blurb in the New England Journal of Medicine stated unambiguously that patients hardly ever become addicted to narcotic painkillers.

And it has been cited in other journal papers — usually positively — more than 600 times since it was published, a new Canadian study documents.

Matthew Sherwood for Postmedia News

That would be highly unusual for a full-blown research paper and “unthinkable” for a letter, say the authors from Toronto’s Institute for Clinical Evaluative Sciences.

They found the citations peaked in the late 1990s and early 2000s, as the drug OxyContin was rolled out and specialists — often funded by opioid manufacturers — widely promoted the notion that narcotic painkillers were a safe, effective option for people with chronic, non-cancer pain.

Such drugs had previously been reserved mainly for terminal cancer patients.

“It was critical to the genesis and propagation of the crisis,” said Dr. David Juurlink, lead author of the new study and a clinical toxicologist at Sunnybrook Health Sciences Centre.

It was leveraged to destigmatize opioid use

“The key thing about this paper … is that it was leveraged to destigmatize opioid use.”

Indeed, Canadians’ consumption of the medicines took off, making this country second only to the U.S. in per-capita ingestion of narcotics.

At the same time, addiction and overdose deaths have reached epidemic proportions, and what started as a medical phenomenon is now a thriving street practice, too.

“It really is a very powerful illustration of what I think is the greatest scandal in modern medical history,” Dr. Mel Kahan, an addictions expert at Toronto’s Women’s College Hospital, said about the new study.  “This is a lesson. Thousands of people have died as a result of doctors’ prescriptions.”

Derek Ruttan/ The London Free Press /QMI Agency

Dr. Jeffrey Drazen, editor of the New England Journal, said the letter’s conclusions may have been somewhat overstated, but argued the main problem was how it was misinterpreted by others over the years.

Its posting on the journal website will now include a notice “for reasons of public health” about that misuse and a link to the Canadian article, he said in an interview.

But, Drazen added, “It’s impossible to know what role this has had in the opioid epidemic. It’s a very multi-faceted thing.”

The 1980 article by Dr. Herschel Jick and a colleague at the Boston University Medical Center, called “Addiction rare in patients treated with narcotics,” examined 11,882 patients with no history of drug-dependency who received at least one narcotic while in hospital. They found only four cases of addiction.

A concussion, also known as a mild traumatic brain injury (MTBI), is caused by a bump, blow, or jolt to either the head or the body that causes the brain to move rapidly inside the skull. A concussion changes how the brain normally functions.

Concussions are a major component of what the Brain Injury Research Institute studies. Concussions can have serious and long-term health effects, and even a seemingly mild ‘ding’ or a bump on the head can be serious.

Signs and symptoms of concussion include headache, nausea, fatigue, confusion or memory problems, sleep disturbances, or mood changes; symptoms are typically noticed right after the injury, but some might not be recognized until days or weeks later.

How many sports concussions occur each year?

An estimated 1.6-3.8 million sports- and recreation-related concussions occur in the United States each year.

During 2001-2005, children and youth ages 5-18 years accounted for 2.4 million sports-related emergency department (ED) visits annually, of which 6% (135,000) involved a concussion.

In what sports are concussions most often reported?

In organized high school sports, concussions occur more often in competitive sports, with football accounting for more than 60% of concussions.

For males, the leading cause of high school sports concussion is football; for females the leading cause of high school sports concussion is soccer.

Among children and youth ages 5-18 years, the fi ve leading sports or recreational activities which account for concussions include: bicycling, football, basketball, playground activities, and soccer.

What is known about sports concussion risk and recovery?

High school athletes’ recovery times for a sports concussion are longer than college athletes’ recovery times.

High school athletes who sustain a concussion are three times more likely to sustain a second concussion.

Lack of proper diagnosis and management of concussion may result in serious long-term consequences, or risk of coma or death.

What should you do if you think you or your child has had a concussion?

Seek medical attention right away.

  • A health care professional will be able to decide when it is safe to return to sports.

Do not return to play with a known or suspected concussion until evaluated and given permission by an appropriate health care professional.

  • Second concussions that occur before you have recovered can be very serious.

Tell your coach or child’s coach about any recent concussions.


Concussion Facts

  • According to CDC estimates, 1.6-3.8 m sports and recreation related concussions occur each year in the U.S.
  • 10% of all contact sport athletes sustain concussions yearly.
  • Brain injuries cause more deaths than any other sports injury. In football, brain injuries account for 65% to 95% of all fatalities. Football injuries associated with the brain occur at the rate of one in every 5.5 games. In any given season, 10% of all college players and 20% of all high school players sustain brain injuries.
  • 87% of professional boxers have sustained a brain injury.
  • 5% of soccer players sustain brain injuries as a result of their sport.
  • The head is involved in more baseball injuries than any other body part. Almost half of the injuries involve a child’s head, face, mouth or eyes.
  • An athlete who sustains concussion is 4-6 times more likely to sustain a second concussion.
  • Effects of concussion are cumulative in athletes who return to play prior to complete recovery.
  • Up to 86% of athletes that suffer a concussion will experience Post-Traumatic Migraine or some other type of headache pain. In fact, recent evidence indicates that presence and severity of headache symptoms may be a very significant indicator of severity of head injury and help guide return to play decisions.
  • 1.5 million Americans suffer from traumatic brain injuries
  • A traumatic brain injury occurs every 15 seconds
  • It’s the number one cause of death in children and young adults
  • Fewer than 1 in 20 will get the facts they need
  • It causes 1.5 times more deaths than AIDS

What should I do if my child has a concussion? CALL YOUR FAMILY PHYSICIAN TODAY AND ASK THEM TO JOIN ORCA! (http://dripamerica.org/pro-iv-moms/)