it opioids which is prescribed by a doctor will need to addiction is extremely low people like russell portnoy and many others were teaching that addiction was rare and these false words and that we should be comforting people in chronic pain just like we have learned to convert people with cancer pain and in fact if you don't do that you're probably going to be found wanting these are what is termed in the industry a k o well or a key opinion leader and if a drug company can hire these k o l's they don't have to do the promotion themselves and in fact a lot of what the k o l say to other doctors and other practitioners doesn't have to meet the same level of scrutiny by the f.d.a. doesn't have to even conform to the labeling instructions for the drug a generation of physicians were trained that opioids were effective for chronic pain and unsafe blitz number to promote the drug they increased their sales force and their physician called list these sales reps were offered lucrative bonuses their average compensation a produce sales rep was about $55000.00 but they could get that increased by an

evangelists for this new pain management revolution was a specialist at sloan kettering named russell portnoy. >> the possibility that a patient becomes like a street addict when given narcotic drugs for pain -- and i'm talking about a patient with no prior history of substance abuse -- is so unlikely that we don't even discuss it. we don't view it as a credible risk. >> as evidence for the safety of opioids, dr. portnoy and others cited a five-sentence letter to the editor published by two boston researchers, her shell gymnastic and jane porter, in 1980. >> the letter was about 100 words to the new england journal of medicine, and essentially it was a study of a small group of patients in a hospital setting, which suggested that if you were given opioids for the treatment of pain, there was a less than 1% chance of addiction. >> but the letter was never intended as a study. it applied only to patients in hospitals. nevertheless, some took the letter and ran with it. >> once that interpretation had been given, it then gets repeated without anybody really going back and looking at the original