What the media gets wrong about opioids

What the media gets wrong about opioids – By Maia Szalavitz – Aug 2018

After Jillian Bauer-Reese created an online collection of opioid recovery stories, she began to get calls for help from reporters. But she was dismayed by the narrowness of the requests, which sought only one type of interviewee.

They were looking for people who had started on a prescription from a doctor or a dentist,” says Bauer-Reese, an assistant professor of journalism at Temple University in Philadelphia. “They had essentially identified a story that they wanted to tell and were looking for a character who could tell that story.”  

Just like the latest research on opioids, the result is assumed before they even start. I don’t understand how this negligence became standard practice.

Although this profile doesn’t fit most people who become addicted, it is typical in reporting on opioids.

Often, stories focus exclusively on people whose use started with a prescription; take this, from CNN (“It all started with pain killers after a dentist appointment.”), and this, from New York’s NBC affiliate (“He started taking Oxycontin after a crash.”)

Alternatively, reporters downplay their subjects’ earlier drug misuse to emphasize the role of the medical system, as seen in this piece from the Kansas City Star. The story, headlined “Prescription pills; addiction ‘hell,’” features a woman whose addiction supposedly started after surgery, but only later mentions that she’d previously used crystal meth for six months.

The “relatable” story journalists and editors tend to seek—of a good girl or guy (usually, in this crisis, white) gone bad because pharma greed led to overprescribing—does not accurately characterize the most common story of opioid addiction.

Most opioid patients never get addicted and most people who do get addicted didn’t start their opioid addiction with a doctor’s prescription.

The result of this skewed public conversation around opioids has been policies focused relentlessly on cutting prescriptions, without regard for providing alternative treatment for either pain or addiction.

80 percent start by using drugs not prescribed to them, typically obtained from a friend or family member, according to surveys conducted for the government’s National Household Survey on Drug Use and Health

Most of those who misuse opioids have also already gone far beyond experimentation with marijuana and alcohol when they begin: 70% have previously taken drugs such as cocaine or methamphetamine.

Conversely, a 2016 review published in the New England Journal of Medicine and co-authored by Dr. Nora Volkow, put the risk of new addiction at less than 8 percent for people prescribed opioids for chronic pain. Since 90 percent of all addictions begin in the teens or early 20s, the risk for the typical adult with chronic pain who is middle aged or older is actually even lower.

The industry flooded the country with opioids and excellent journalism has exposed this part of the problem. But journalists need to become more familiar with who is most at risk of addiction and why—and to understand the utter disconnect between science and policy—if we are to accurately inform our audience.

The innocent victim narrative

This one irritates me no end and I’m disgusted to what level it has invaded the culture and vanquished reality.

I’m not even sure why so many people want to believe this, which is what it takes for an idea to become widely accepted. Any hints?

…highlighting “innocent” white people whose opioid addiction seems to have begun in a doctor’s office sets up a clear contrast with the “guilt” of people whose addiction starts on the streets.

Rather than skeptically investigating, however, members of the media enlisted themselves as happy drug warriors throughout the 1980s and ’90s.

Sensational stories focused on crack and its users as the cause of the problem, frequently ignoring that addiction hits hardest in communities facing high unemployment, de-industrialization, cuts in benefits, and loss of hope

Now that the problem is seen as “white,” however, socioeconomic factors and other reasons that people turn to drugs are more commonly discussed.

The result is that today’s white drug users are portrayed as inherently less culpable

Craig Reinarman, professor of sociology emeritus at the University of California, Santa Cruz, has documented biased coverage of addiction since before the crack era. “Now that the iconic user is white and middle class, the answer is no longer a jail cell for every addict, it’s a treatment bed,” he says.

Criminalization still deeply affects our sympathy for people with opioid addiction. This headline recently appeared in the Times: “Injecting Drugs Can Ruin a Heart. How Many Second Chances Should a User Get?” Is that a question reporters would ask about people with diabetes who don’t follow their diet or those with heart disease who don’t exercise?

It’s important for journalists to understand that criminalization is not some sort of natural fact, and laws are not necessarily made for rational reasons.

Our system does not reflect the relative risks of various drugs;legal ones are among the most harmful in terms of their pharmacological effects

In order to do better, journalists must recognize that addiction is not simply a result of exposure to a drug, and that “innocence” isn’t at issue.  

Please, no more reports of DEA agents having overdoses because they touched some fentanyl.

Powdered fentanyl cannot be absorbed through the skin. Only fentanyl that has been processed into a gel film for patches, and then with a delay of a few days while it gets through the skin.

Doesn’t it occur to anyone that such a story is a likely lie to cover up the agent’s own voluntary drug use when they overdose?

The critical risk factors for addiction are child trauma, mental illness, and economic factors like unemployment and poverty.

The “innocent victim” narrative focuses on individual choice and ignores these factors, along with the dysfunctional nature of the entire system that determines a drug’s legal status.

The difference between dependence and addiction

Widespread conflation of addiction and dependence further mars opioid coverage.

These days, experts from the National Institute on Drug Abuse and the authors of the Diagnostic and Statistical Manual, now DSM-5, agree that the core of addiction is compulsive drug use that continues regardless of bad outcomes.

(See Addiction, Dependence, and Tolerance)

The critical difference between addiction and dependence becomes clear when you look at specific drugs:

  • Crack cocaine, for example, doesn’t cause severe physical withdrawal symptoms, but it’s one of the most addictive drugs known.
  • Antidepressants like Prozac, meanwhile, don’t produce compulsive craving the way cocaine can, but some have severe withdrawal syndromes.

And then Ms. Szalavitz makes three excellent points that demonstrate why the use of opioids by pain patients does not constitute addiction:

  1. Needing opioids for pain alone, then, doesn’t meet the criteria for addiction.
  2. If the consequences of drug use are positive and the benefits outweigh the harm from side effects, then that use is no different from taking any other daily medication.
  3. Dependence in and of itself isn’t a problem unless the drug isn’t working or is more harmful than it is helpful.

Unfortunately, while the scientific understanding has changed to reflect these facts, the press hasn’t caught up.

The Washington Post conducted a poll of pain patients on opioids that labeled one third of them as addicted after they responded “yes” to a question that asked whether they were “addicted or dependent,” without defining either term.

This would be a mere semantic issue if it didn’t have such awful effects on policy.

Conflating addiction and dependence results in harm to pain patients, children exposed to opioids in utero, and people who take medication to treat addiction.

Any pain patient who takes opioids daily for long enough will develop physical dependence and suffer withdrawal if the medication isn’t tapered slowly. But if either the doctor or the patient sees this dependence as addiction, then the patient is at risk of being cut off from medication that is actually helpful.

In some instances, hundreds or even thousands of patients have been forcibly tapered from opioids in an attempt to comply with federal guidelines and law enforcement pressures, without regard for individual medical circumstances or needs

To make matters worse, mistaking dependence for addiction also harms people who take treatment medications like methadone or buprenorphine, which are the only two therapies proven to cut the death rate by 50 percent or more.  

These medications don’t produce any intoxication once an appropriate and regular dosing schedule is instituted.

They relieve the compulsion and the consequences that are the hallmark of addiction. However, they only work for as long as people stay on the meds—in other words, patients remain dependent.

Sadly, even if patients have gone from being homeless and unemployable to being productive workers, the fact that they are still on medication means that they are often stigmatized as being “not really” in recovery—indeed, if dependence is the same as addiction, they aren’t. This misconception leads many to prematurely stop, often resulting in overdose death.

It’s important for journalists to explain these distinctions—to ensure that both pain patients and people with addiction have access to appropriate medication.

How to change your language, and your coverage

The AP urges its members not to conflate addiction and dependence for precisely the reasons listed above, and also warns against using the term “drug abuse”—which, like “dependence,” has been removed from the DSM. “Misuse” is more accurate and less moralistic.

Ask yourself if you are covering addiction the way you would any other medical disorder.

  • Would you rely on police as sources to discuss patients’ behaviors or pharmacology?
  • Would you accept claims about patients that frame them fundamentally dishonest by nature?
  • Would you highlight only “innocent” victims of the disease?

Don’t accept claims about what works in addiction treatment at face value. Ask for research supporting treatment outcomes. If it doesn’t exist, or if there is data on similar programs having poor outcomes, include these facts.

Be as skeptical of claims about work or spiritual cures as you would be for cancer care.

The addiction treatment industry simply is not professionalized in the way other health care is. Many treatment providers have little training beyond their own experience with addiction and are not familiar with the research. Don’t give self-interested claims about treatment outcomes or the supposed superiority of self-help groups the same weight as peer-reviewed data—and make sure you include peer-reviewed research whenever you cover medication and behavioral treatment.

Ensure that your audience knows that our system of drug laws is not based on scientific information about drugs.

Finally, if you think you know a fact about substance misuse, check it.

Isn’t this how journalists *always* work? What has happened to journalism that this behavior has to be specified? Or is it only when it comes to this topic that journalists don’t fact-check?

Some of the best stories come from simply exploring the research that shows that most of what we think we know about drugs is completely wrong.  

For a reality check about the “addiction crisis”, wrongly called an “opioid crisis”, see ATIP’s white paper.

 

2 thoughts on “What the media gets wrong about opioids

    1. Zyp Czyk Post author

      Yes, Maia Szalavitz is one of the too rare writers who totally “gets it”. Her experience with heroin addiction give her a very realistic view into this crisis.

      Like

      Reply

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