Dreamland: The True Tale of America's Opiate Epidemic

by Sam Quinones

By the 1990s, it would have alarmed Dr. Hershel Jick, out in Boston, to know that his letter to the editor of the New England Journal of Medicine, which he had long forgotten, had become a foundation for a revolution in U.S. medical practice. This was wildly beyond anything Herschel Jick intended when he penned it. But that’s what happened. The revolution extended to hospitals, medical clinics, and family practices across the country. It’s unclear who retrieved the Porter and Jick letter from obscurity. But it appears to have been cited first as a footnote in Kathy Foley and Russell Portenoy’s 1986 paper in Pain. In time, the paragraph became known simply as Porter and Jick. That shorthand, in turn, lent prestige to the tiny thing and the claim attributed to it: that less than 1 percent of patients treated with narcotics developed addictions to them. That “less than 1 percent” statistic stuck. But a crucial point was lost: Jick’s database consisted of hospitalized patients from years when opiates were strictly controlled in hospitals and given in tiny doses to those suffering the most acute pain, all overseen by doctors. These were not chronic-pain patients going home with bottles of pain pills. It was a bizarre misinterpretation, for Jick’s letter really supported a contrary claim: that when used in hospitals for acute pain, and then when mightily controlled, opiates rarely produce addiction. Nevertheless, its message was transformed into that broad headline: “Addiction R...