When Medicine Lost Its Compass

After more than a decade inside the opioid system, I learned that accountability in medicine has to reach beyond the prescription pad.

Evidence in medicine is supposed to protect patients. It’s meant to separate what works from what harms. But evidence only works when it’s used honestly and understood in context. The 1980 letter by Porter and Jick is a reminder of what happens when it isn’t (Porter & Jick, 1980). The single-paragraph letter to the New England Journal of Medicine was a brief observation about hospitalized patients who had been given opioids while inpatient, and was not a study of long-term use, addiction, or community prescribing. Yet it was repeatedly cited as proof that opioids were safe and rarely addictive.

Leung et al. (2017) later demonstrated how often that letter was taken out of context and amplified in the medical literature. Hundreds of papers leaned on it to justify prescribing practices that eventually reshaped American medicine. Porter and Jick’s single paragraph helped turn caution into confidence, and confidence into crisis.

When the Data Meets the Patient

By the time the echoes of that single paragraph had spread through medicine, I was already part of the story it helped create. In 1999, I became a patient, someone living with real pain and real trust in the science that promised to help. My healthcare providers weren’t careless. They were following what they’d been shown was safe, supported by data that appeared sound. I didn’t know it then, but I had stepped into a system already bending under the weight of misconstrued evidence and misplaced confidence.

The prescriptions came in measured bottles, wrapped in the language of progress. Each refill carried a subtle message: the pain was being treated, the science was working, and I was getting better. Only later would I see that the trust I placed mirrored the trust medicine had placed in a single, untested idea. I didn’t realize I’d become both subject and proof, one more life folded into the data that would define an entire generation of patients. Medicine’s systemic failure wasn’t in the data itself, however, but in how people used it.

When Trust Becomes the Vector

Real evidence demands skepticism, replication, and humility, especially in the pharmaceutical industry, where profit and pain often intersect. The misuse of Porter and Jick’s 1980 letter taught an entire generation that even the smallest piece of evidence, when misunderstood or, dare I say, weaponized by a single drug company hellbent on profit-defined progress, can destroy trust.

I entered the system in 1999, when OxyContin had only recently been released and was being promoted as a safer, time-released alternative for pain. It started with trust in my provider and belief in the science behind those pills. Over time, as prescribed dosing only increased month after month, year after year, the medication took more than it gave. By 2010, I decided to stop being a patient and walked away from my doctor’s treatment plan.

I quit cold turkey after more than a decade of legal, medically induced opioid addiction. When I got clean, because that is exactly what I did, I went cold turkey, not out of strength but out of necessity. What those years taught me is simple: evidence only matters when medicine remembers who it’s for. But under the watchful care of my provider, I was the user and they were the dealer.

Pain as a KPI

Prescription practices matter, but they’re only one layer of the opioid epidemic. Tightening regulations on doctors can prevent overprescription, yet it doesn’t undo the conditions that made pain a commodity and patients expendable. The deeper problem lies in how healthcare systems reward volume over vigilance and how pain itself became a KPI.

I don’t believe the solution is to punish physicians who prescribed in good faith based on the evidence they were given. Most followed the guidance of an industry that blurred the line between marketing and medicine. Real change has to go further, into education, monitoring, and rehabilitation that treat addiction as a medical outcome, not a moral failure.

Addiction Is a Medical Outcome

As Volkow (2020) points out, addiction is a chronic brain disease shaped by environment, genetics, and access to treatment. It isn’t solved by blame or punishment but by prevention and compassion. Focusing only on prescription practices misses the need for community-based programs that reduce stigma and make recovery sustainable. Medication-assisted treatments, counseling, and follow-up care must be readily available long after the initial crisis has passed. Otherwise, relapse is almost certain. Even at the pen of a doctor, make no mistake, it is a relapse.

Prevention must begin before the first prescription. That means transparent data, honest drug labeling, and systems that prioritize long-term well-being over quick relief. It also means giving doctors the time and support to manage pain without relying on pills as the only answer. Pain should never be measured by satisfaction survey scores or treated through convenience.

After the Epidemic: Pain Without Trust

Two decades later, the pendulum has swung the other way. The same system that once treated pain as a performance metric now treats it as suspicion. Patients with chronic pain face scrutiny, barriers, and disbelief, their suffering filtered through a lens medicine created and then disowned. The irony is brutal: the industry that overprescribed now under-listens.

Those who live with real, ongoing pain are caught between fear and stigma. Doctors hesitate, pharmacists question, and patients are left to navigate agony in silence. The system that once flooded lives with prescriptions now denies them out of guilt, as if refusing treatment could erase the past. In trying to destroy the monster it created, medicine learned to fear the people it failed.

Pain management should not swing between extremes. Accountability must exist without cruelty, and caution without neglect. Healing begins when trust can return to both sides of the prescription pad.

Different Labels, Same Cycle

I lived through the years when OxyContin was treated like progress, not risk. The lesson I carry is that accountability must extend beyond the prescriber’s pen. It must include the structures that turned relief into dependency and patients into statistics. Until healthcare stops conflating profit with progress, the cycle will continue, just with different labels.

I saw firsthand how easily a single piece of misplaced evidence can reshape lives, mine included. Eleven years of over-prescription isn’t just a statistic; it’s the human cost of how medicine lost its compass. I never chased the high or broke the rules, but make no mistake, I was addicted. It didn’t start as a choice, but it sure as hell ended as one.

About the Author

Kenneth Raymond was first diagnosed with CMT1 in late 2002 at the age of 29 and genetically confirmed with CMT1A a year later. Treating his chronic pain became part of his diagnostic journey. Since then, he has devoted his life to studying, researching, and understanding all aspects of CMT, with a focus on the genetics of the disease. Currently pursuing an MS in Genetics, Cell, and Developmental Biology at Arizona State University, Kenneth’s commitment to advancing knowledge and improving the lives of those living with CMT remains as strong as ever.

References

Leung, P. T. M., Macdonald, E. M., Stanbrook, M. B., Dhalla, I. A., & Juurlink, D. N. (2017). A 1980 letter on the risk of opioid addiction. New England Journal of Medicine, 376(22), 2194–2195. https://doi.org/10.1056/NEJMc1700150

Porter, J., & Jick, H. (1980). Addiction rare in patients treated with narcotics. New England Journal of Medicine, 302(2), 123. https://doi.org/10.1056/NEJM198001103020221

Volkow, N. D. (2020). Addressing the stigma of addiction — Essential to ending the opioid epidemic. New England Journal of Medicine, 379(24), 2119–2120. https://doi.org/10.1056/NEJMp1917360