Response to Lustman et al. Letter
Abstract
TO THE EDITOR: Although we disagree with the extrapolation of the incidence rates presented by Lustman et al., we agree with the important advice they offer regarding the urgent need for greater vigilance to stop this growing problem. It is not logically possible to apply the 0.2% incidence rate found in Fishbain and colleagues' study (1) to estimate the percentage of new cases of opioid use disorder in people who have no history of substance use disorder. The populations in these studies are entirely different, which precludes using statistics from one to draw conclusions about the other. The question of what percentage of people who have no history of substance use disorder develop abuse or dependence on opioid painkillers is important. It is a hotly debated topic for which little data exists. The 0.2% rate we cited of opioid abuse or dependence among people with no previous history of substance use disorder was revealed by Fishbain et al. (1) after a meticulous and thorough review and compilation of data from previous studies. We believe this represents the best data available regarding this question. The authors themselves expressed some surprise at the low percentage. They noted that the studies