Stigma Over Solutions

Four Democratic senators held a press conference on June 15 to highlight what the passage of the American Health Care Act (aka Trumpcare) would do for the opiate crisis. The conference came just days after a report showed overdoses are now the leading cause of death among Americans under 50 (New York Times, 6/5/17), and days before GOP senators released their secretly crafted version of health reform (Washington Post, 6/22/17) that will make it worse in countless ways. Under these dire circumstances, one would hope the room would have been filled with reporters.

Vox’s Jeff Stein posted a photo on Twitter, however, which showed, sadly, just a handful of journalists in attendance: “Does it look commensurate with massive looming crisis for ~20 million people? Or like business as usual?”

That media paid so little attention (there was almost no national coverage) to such an important topic is one of the many major problems with the corporate media coverage of the opiate epidemic. While there is never a good time to gut Medicaid and throw 22 million off their health insurance, it is especially worrying that it may happen in the middle of a tragic opiate epidemic that is being covered by the media in all the wrong ways.

For decades coverage of drug policy helped fuel the racist, wrong-headed drug war (Extra!, 9–10/98), which led to policies such as draconian mandatory minimum sentences and laws refusing financial aid to anyone convicted of drug-related crimes, which were particularly hard on the African-American community, due to racial disparities in arrests and sentencing. “News media are not presenting things as they are—but rather as racial fears project them to be. And a racialized policy agenda is being served up and served,” as FAIR’s Mikal Muharrar noted in an analysis of racial profiling in the media in 1998 (Extra!, 9–10/98). “Too often, we don’t get the reality of what really is, or the dream of what should be, but an imaginary nightmare in blackface.”

Now that addiction has “a white face,” as Ekow Yankah (New York Times, 2/9/16) put it, the tone has shifted, toward a supposedly more humane approach. But even as reporters display more sympathy (New York Times, 10/30/15), media are still failing to help solve the crisis. Overdoses continue to rise (New York Times, 6/5/17), racial disparities in the criminal justice system are still rampant (Slate, 8/9/15), and dominant media often treat the opiate crisis as fodder for anecdotal, often sensationalized stories about a sad phenomenon, not a massive health emergency begging for serious and urgent policy reforms. Further, studies show most reports covering opiate abuse still portray it as a criminal issue, as opposed to the health crisis that it is.

The medications that are the most effective treatment available are often vilified in the media as being no better than the illegal drugs they treat. This contributes to a stigma that, according to researchers at John Hopkins University (4/16/14), dissuades “people who use opioids from seeking effective services,” and “is impeding progress in reducing the toll of overdose.”

There are real solutions to the opiate problem that require sensible policies and a public that understands the nature of addiction. By failing to cover these remedies in a serious way, corporate media have enabled the opiate crisis to get worse.

Sensationalism Over Solutions

NYT: From Opioid Epidemic’s Front Lines, Filling In the Brutal Back Story

The New York Times (6/19/17) takes the “scared straight” approach.

In the weeks following the Democrats’ press conference about the opiate crisis and Trumpcare, the New York Times made no mention of it. The next major article about the epidemic itself, published four days after the conference (6/19/17), illustrated how the press largely ignores treatment and relies on sensationalism over solutions.

The article profiled Frank Whitelaw, a county coroner in Elizabethtown, New York, with a unique approach to warning young students about the dangers of opiates: “In contrast with the relatively sanitized classroom instruction…his talk was meant to pack an emotional wallop,” the Times reported.

Whitelaw gives students a PowerPoint presentation showing “crime-scene photos of a victim of an opioid overdose—a graduate of that high school, her face purplish-blue, her right hand still clinging to a cigarette lighter.” He describes how women find liquid fentanyl, the dangerous drug often mixed with or sold as heroin, and “stick it in their vaginas.”

His tactic is reminiscent of the “scared straight” approach often seen on television, where prisoners attempt to frighten kids out of a life of crime. This type of deterrence doesn’t work, according to researchers, who have found such approaches “ineffective, and even potentially harmful” (Pediatrics, 3/05; Psych Central, 11/26/10).

The word “crime” is used twice and “death” is used six times, but the word “medication” appears nowhere in the Times article. There is no reference to any of the pharmaceuticals that are widely accepted as most effective at reducing overdoses: buprenorphine, Suboxone, methadone.

The word “treatment” only appears once, near the very end, and it is placed on equal footing with law-enforcement: “While drug interdiction and treatment are critical in addressing the opioid crisis, Mr. Whitelaw believes the first step is effective education.”

This is exactly the problem, according to a 2015 study in Psychiatric Services (12/1/15), which found that media generally ignore public health solutions, and focus mostly on criminality. Only half of the reports covered over a 14-year period even mentioned solutions at all, and most of the time they had little to do with public health.

Said Dr. Emma McGinty, one of the authors of the study (The Fix, 12/07/15):

The national dialogue around opioid analgesic abuse still frames this issue predominantly as a criminal justice issue rather than as a public health problem or treatable health condition.

Demonization of Evidence-Based Treatment

It is worth noting that the Times article about Whitelaw’s powerpoint presentation wasn’t dug up in an effort to find an egregious example of this kind of reporting. It was literally the first major article the paper of record produced on opiate addiction following the June 15 press conference.

NPR: How An Opioid Treatment Could Be Contributing To The Problem

NPR report (6/19/17) on the “dark side” of life-saving addiction treatment.

More egregious examples, however, aren’t hard to find—in many cases, not ignoring but demonizing treatment. A recent NPR story (6/19/17) about the medication buprenorphine (marketed as Suboxone) is an appalling example of this.

“When used correctly, [suboxone] can help addicts recover,” notes the report’s only clause that portrays the life-saving drug in any esteem, “but it has a dark side…. Some doctors are selling the drug illegally, making the opioid crisis worse.” Then comes the stern warning that “Kentucky’s attorney general, Andy Beshear, said he is not taking this new Suboxone issue lightly. He is cracking down.”

The article is misleading and irresponsible. Suboxone and other medication-assisted treatments (MAT) are, according to an overwhelming medical consensus, the most effective available remedy for opiate abuse. MAT is supported as effective treatment by, among others, the Department of Health and Human Services (HHS), the Substance Abuse and Mental Health Services Administration, the US Surgeon General, the National Institute on Drug Abuse and the Centers for Disease Control.

Yet here is a respected news organization amplifying a narrative that the drug—which is non-euphoric when taken by patients with a tolerance to opiates—is extremely dangerous. There is no reference to the effectiveness of the drug, no counterpoint from an expert to oppose the Kentucky politician. And the story aired nationally, adding stigma to a drug that will likely prevent many people who need the treatment from seeking or receiving it.

“The coverage from NPR, like so much of the coverage of medication-assisted treatment, is still really poor,” Zachary Siegel, who writes extensively about addiction treatment, told FAIR. He argues that critics of MAT are often at odds with the hard scientific data:

On some level—and I may be guilty of this myself—it is worth asking if she should even quote these blatantly false statements about addiction and medication. It is like global warming. When the scientific consensus is this overwhelming, there really isn’t “two sides” to the story.

The facts are indeed staggering, as Siegel notes in Slate (11/30/16). Numerous studies have shown MAT to reduce overdose deaths—by 80 percent in France, 75 percent in Australia and 66 percent in Baltimore. “These studies are rarely covered or even mentioned in most articles,” he told FAIR.

Press and Trump Administration Both Perpetuate Stigma

NYT: Addiction Treatment With a Dark Side

The New York Times (11/16/13) called buprenorphine a “double-edged drug” because it had been linked to 420 deaths over 10 years–treating an illness that had killed about 300,000 people over the same period of time.

This has been going on for years. In 2013 the New York Times (11/17/13) issued a now infamous two-part report on the “dark side” of drug treatment, declaring that “buprenorphine has become both medication and dope,” infuriating medical experts and addiction treatment advocates (Salon, 12/22/13).

Just weeks later, the Times (12/8/13) ran a five-part series on a homeless child that decried her parent’s methadone maintenance therapy as just a “substitute addiction.” Would the author prefer the child’s parents seek no treatment, or treatment not backed by science? ”Clients on opiate-replacement therapy struggle daily with feelings of shame that their recovery ‘doesn’t really count,’” explained Sarah Beller, a writer and employee at a mental health clinic, in response to the Times’ reporting (Salon, 12/22/13).

In 2007, the Baltimore Sun (12/16/07) ran a similarly one-sided series, barely mentioning the successes of the drug and instead reciting the temperance movement’s belief that someone on medication is “substituting one addiction for another.” As health reporter Maia Szalavitz wrote of the Sun’s article (Huffington Post, 1/16/08):

This implies that continuing on maintenance is not really recovery but “being hooked.” But methadone and buprenorphine are safe for long-term use—a fact the Sun doesn’t emphasize.

As this narrative is pushed by major media outlets, it should not be surprising that Republican politicians, never the strongest advocates for science (, 12/4/16), parrot the falsehoods. Trump advisor Kellyanne Conway, when asked about the AHCA’s negative impact on the problem, said on ABC’s This Week (6/25/17) that those suffering from addiction need “a four-letter word called will.” HHS Secretary Tom Price claimed in May, against the findings of his own agency, that maintenance drugs are just “substituting one opioid for another.”

Interestingly, NPR (5/16/17) was among those who reported how “unscientific” Price’s claims were, according to experts.  Clearly NPR is capable of reporting reasonably responsibly on the issue of addiction treatment—though the opportunity to showcase yet another example of the Trump administration’s anti-science attitudes (Scientific American, 1/18/17) no doubt played a role.

Why Coverage Can and Must Improve

Another positive step occurred last month when the Associated Press updated its stylebook (5/31/17)—seen as the industry standard for editors and journalists—to try to decrease the use of stigmatizing language when covering addiction. Clearly many in media are aware of the news industry’s failings in covering this epidemic.

With the GOP attempting to gut Medicaid, the public needs the press to report on possible solutions to the opioid crisis absent the stigmatizing, drug-war emphasis that dominated coverage for years. Changing the national dialogue about addiction, and about treatment, is a matter of life and death.

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