It is almost impossible to check the news these days without finding a story about opioids. And there’s good reason: The toll opioids now take on Americans’ health is staggering. After more than two decades of increasing overdose rates, an American is now more likely to die of drug poisoning than in a motor vehicle crash.
As public-health scientists who study opioid addiction and how to best help people access quality treatment, we are reassured to see this epidemic finally getting the attention it deserves. However, as opioid-related media coverage has proliferated, so have a number of troubling mischaracterizations about the nature of opioid addiction and its treatment. These myths matter. The popular press is probably the most important source informing the public about how opioids are affecting America. The press has the power to influence the decisions of people struggling with addiction, family members, politicians, and even physicians.
We know most journalists covering the opioid epidemic want to get the story right. We also know that we scientists sometimes struggle to convey our findings clearly. When it comes to addiction, thoughtful communication is even more challenging: A long tradition of shaming substance users has made the press less inclined to talk about addiction as a public-health crisis rather than a moral one. With that in mind, this article presents a list of four facts every journalist can (and should) use when writing about opioids:
1. Repeated opioid use causes rapid, observable changes in the brain. It might seem baffling that people would continue to misuse opioids even as their lives fall apart around them. However, it is no surprise once we take a look at the biology of opioid drugs, including prescription pain-relievers like OxyContin, illicit drugs like heroin, and powerful synthetic drugs like fentanyl. Opioids flood the brain with pleasure-causing and pain-reducing chemical signals. This is what makes these drugs so effective for short-term pain relief. However, after repeated use, the brain adapts, reducing the amount of these chemicals it releases on its own. Consequently, a person who uses opioids repeatedly will need to take these drugs just to feel normal. Without opioids, the brain’s new balance is disrupted, and the agonizing symptoms of withdrawal and craving set in. Acknowledging even this basic biological underpinning goes a long way toward helping the public understand why addiction to any opioids is a disease, and not a character flaw.
2. There are highly effective treatments for opioid addiction. Although rarely mentioned in media articles, there is a clear scientific consensus that medication-assisted treatments with methadone or buprenorphine (the main ingredient of Suboxone) are the best existing treatments for opioid addiction, and they work pretty well. Studies repeatedly show that patients whose recovery is supported by these medications are more likely to adhere to a treatment regimen, less likely to relapse, and less likely to overdose than patients in traditional abstinence-based treatment. This is because these medications target the biological basis of opioid addiction. By helping to overcome the chemical deficit that develops in the brain of a person with an opioid addiction, these medications can prevent the symptoms of withdrawal and drug craving without producing feelings of euphoria commonly referred to as a “high.” Instead of focusing on stories of persons who failed to “beat” opioid addiction through will power, tough love, and maybe a stint in rehab, the media should inform the public about the benefits of these medications, and highlight stories of success and recovery achieved through appropriate treatment. Recovery from addiction is neither hopeless nor random, but many people who receive treatment for opioid addiction are not receiving the care known to be most effective. The media can help expose this need-treatment gap.
3. The goal of addiction treatment is to restore a person’s ability to lead a meaningful life, function productively, and stay alive. This might seem obvious, but it is often not the goal that the media tends to focus on. Instead, success is often portrayed as “getting clean,” meaning abstinence from any drug use, illicit or otherwise. Equating recovery and abstinence is counterproductive and dangerous because medication-assisted treatment for opioid addiction is most effective as a maintenance treatment taken over an indefinite period of time. This is similar to treatment for other chronic illnesses, for example insulin maintenance for diabetes or statin (Lipitor) maintenance for high cholesterol. However, there is a myth that a person who receives medication-assisted treatment is not actually battling their addiction. In fact, recovery is extremely challenging regardless of whether a person is on medication, but stably and regularly taking medication can help a person improve functioning and better prevent relapse and the negative consequences associated with it, including death. The press would do a great service if, in stories on addiction, recovery, or relapse, it would focus on functional recovery, not mere abstinence from drug use. Abandon the expression “get clean.” Any treatment which allows a person to work, raise a family, fulfill social roles without impairment, and of course stay alive, should be welcomed and applauded.
4. A person might have an addiction, but this does not make him or her “an addict.” As a society, we have stopped calling people with schizophrenia “schizophrenics” or people with leprosy “lepers.” People with these illnesses are people first, with families, emotions, and aspirations. Many people with an opioid addiction refer to themselves as addicts, and we understand and respect this is their right, consistent with common cultural norms. But the word addict carries heavy negative connotations, and the press should not foist this label on persons who are struggling with a chronic illness. The media should instead hold itself to the highest standard, one that humanizes members of our society who are often the most vulnerable and discriminated against.
The press should be commended for finally raising the profile of a public-health problem that has been obscured for decades, and for communicating with the public, which we as scientists so often fail to do. We hope journalists who view news as a vehicle for driving positive social change will find these recommendations helpful; increased awareness of the problem of opioids alone will not end this epidemic without appropriate framing, compassion, and context informed by scientific evidence.
CJR’s health care reporting is sponsored in part by a grant from the Commonwealth Fund.