Three months ago, Donald Trump promised to spend "a lot of money" on "very, very bad commercials" that would "scare" teenagers away from opioids by depicting "pretty unsavory situations." Today the White House unveiled four of those government-sponsored ads, and they are indeed very, very bad, in the sense that they rely on deceptive tropes and misleading half-truths.
"The first four ads, which are based on real life, tell the graphic stories of four young adults going to extreme lengths to maintain their prescription opioid addiction," says White House Press Secretary Sarah Huckabee Sanders. "These ads show young adults how quickly opioid addiction can occur, and the extreme lengths to which some go to continue use of drugs while in the grips of addiction."
All four ads feature young people who deliberately injure themselves so they can obtain prescription pain medication. Amy crashes her car into a dumpster, Kyle smashes his hand with a hammer, Chris closes his arm in a door, and Joe drops a car on himself by crawling under it and releasing the jack. "I didn't know they'd be this addictive," each of them says in a voice-over narration. "I didn't know how far I'd go to get more."
As is traditional in anti-drug propaganda, these spots present extreme outcomes as common, grossly exaggerating the chances that any given drug user will end up like the pathetic souls they depict. That approach won't be credible to anyone who knows better, and it does a real disservice to people who need opioids to relieve severe pain by portraying medical use of these drugs as a gateway to hellish addiction.
Two of the four self-maimers (Amy and Joe) say they got hooked on pills that were prescribed for pain, suggesting that opioid addiction begins that way something like 50 percent of the time. But that scenario is actually pretty rare. Nonmedical users generally do not get opioids through prescriptions written for them, and people who become addicted to pain pills typically use a variety of drugs and have histories of substance abuse. In a 2007 study of people entering treatment for addiction, 78 percent of the OxyContin users "reported that the drug had not been prescribed to them for any medical reason." Almost all of them used other drugs in addition to OxyContin, and three-quarters of them had previously been treated for substance abuse.
The risk of addiction for bona fide patients is low—something like 1 percent among people treated for acute pain, as Amy and Joe were. The risk of addiction is low even when you include nonmedical users. According to the 2016 National Survey on Drug Use and Health (NSDUH), about 2 percent of the people who used prescription opioids that year, whether legally or illegally, experienced a substance use disorder (SUD). By comparison, the same survey indicates that 9 percent of drinkers experienced an alcohol use disorder in 2016.
The website for the anti-opioid ad campaign nevertheless insists that prescription opioids are "highly addictive," and the ads reinforce that message. That pretense will be hard to maintain, because it is contradicted by everyday experience. According to NSDUH, 92 million Americans used pain pills in 2016, and maybe 2 million qualified for an SUD diagnosis, which includes forms of drug abuse that fall short of addiction. In other words, 98 percent of prescription opioid users did not have experiences anything like the ones portrayed in the government's propaganda. Surely many of the young adults at whom these ads are aimed will have noticed this reality.
Reaching for scientific credibility, the ads warn that "opioid dependence can happen after just five days," implying that prescriptions lasting longer than four days are reckless. But that figure blatantly misrepresents research that shows nothing of the kind.
The ads are alluding to a CDC study that found the likelihood of "continued opioid use"—not "dependence"—rises with the length of the initial prescription. For example, 6 percent of patients who received a one-day prescription were still using opioids a year later, compared to 12 percent of those who received six days of pills and 24 percent of those who initially got a 12-day supply. But continuing to use opioids for a year is not equivalent to addiction, and it stands to reason that patients with longer-lasting pain would tend to get longer initial prescriptions and also be more likely to still need analgesics a year later.
The anti-opioid website bemoans the "nationwide push to take patient pain more seriously," which it blames for causing the "opioid epidemic," and mocks the suffering of people who are unlucky enough to need prescription analgesics: "Unlike something like blood pressure, pain is subjective. One person's IT. IS. A. TEN! is another person's ehhhhsix?, is another person's I'M FINE." This blithe dismissal of the life-warping agony that might lead someone to take opioid pain relievers for longer than a year is of a piece with the pernicious message that patients should avoid such drugs if they don't want to end up like poor Amy and Joe.