In a letter to The New England Journal of Medicine, Dr. Russell Portenoy and Dr. Kathleen Foley presented findings indicating that addiction to opioids was a rare occurrence among patients treated with narcotics for pain management. This communication sought to reassure physicians about the relative safety of these medications when responsibly prescribed in a clinical setting. The authors emphasized that, in their experience, addiction was more likely in a subset of patients with a history of substance abuse rather than those receiving appropriate medical care for pain relief. The letter gained significant visibility within the medical community and was frequently referenced in discussions about opioid prescribing guidelines. This publication coincided with a rising trend toward more aggressive management of pain in clinical settings, which led to an increase in opioid prescriptions.As time progressed, the assertions made in the letter were taken out of context, and many in the medical field began to adopt a permissive stance toward opioid usage for pain management. The idea that addiction was infrequent among users of prescribed opioids contributed to a perception that these medications could be used safely and liberally. Unfortunately, this perspective ultimately contributed to the opioid crisis, as it misrepresented the risk of addiction and led to a surge in opioid prescriptions, resulting in significant public health issues associated with opioid addiction and overdose.