If you have been wondering why, with all the attention paid to opioid addiction by the media, there is still a lack of funding and support for treatment, one answer is in a paper published in the current issue of Psychiatric Services. The vast majority of stories in mainstream newspapers and on broadcast news depict prescription opioid abuse as a criminal, not a health, issue. And that is likely even more true for abuse of illicit drugs like heroin, lead author Emma E. McGinty, Ph.D., of the Johns Hopkins Bloomberg School of Public Health, told ADAW last week.

The article, “Criminal Activity or Treatable Health Condition? News Media Framing of Opioid Analgesic Abuse in the United States, 1998–2012,” reviewed 437 newspaper articles and 236 television stories. McGinty and her colleagues looked at how the stories framed causes of, solutions to and consequences of prescription opioid abuse. They found that, overall, illicit drug dealing was mentioned most frequently (57 percent of stories) as a cause, and law enforcement arrests and prosecutions as a solution (64 percent), with only 3 percent of stories mentioning treatment as a solution. However, for consequences of prescription opioid abuse, the vast majority of stories (95 percent) mentioned health-related consequences, including death and overdose.

With the caveat that the situation has changed since the study period ended in 2012, McGinty said that still, the widespread perception of opioid addiction — or any addiction — is that it is a “moral failing, not a health problem.”

Since 2012, there have been two major changes in the opioid epidemic: more people are now using heroin, and there is a great attention to addiction as a public health issue from public officials. “This was outside of the study period, but we now have some key opinion leaders, especially Michael Botticelli, who have had a treatment message,” said McGinty. Botticelli, director of the Office of National Drug Control Policy since last February, was deputy director before then, starting in November of 2012. And the previous director, R. Gil Kerlikowske, frequently said that treatment and prevention were the solution, using the phrase “We can’t arrest our way out of this problem.”

“I suspect if we were to redo this study, we would see more of that type of messaging,” said McGinty.

Treatment mentions: 3 percent

The study showed a huge gap in any mentions of treatment, even though methadone and buprenorphine were both well-established as evidence-based treatments for opioid use disorders even at the start of the study period. “That was one of the most disappointing aspects of this study,” said McGinty. “Very rarely did we see mentions of methadone or buprenorphine.” There was an increase in mentions of prevention programs — mainly, prescription drug monitoring programs — over the course of the study period, she said. But from 1998 to 2012, as the opioid epidemic and overdoses were increasing, there was “no change in coverage of treatment in general, or of medication-assisted treatment specifically.”

McGinty speculated that the reason news associations left out references to treatment was that they mirror, in their agenda and framing of stories, the views of society. “We as a society, even the most educated and best-intentioned of us, have historically viewed any kind of drug addiction as a moral failing rather than a treatable health condition, and this view is very hard to overcome,” he said.

Another reason is that many in society view the addicted population as “outside of the mainstream,” said McGinty. “We don’t think about our neighbor or family member as someone who could benefit.” This is because of stigma, which keeps many people from disclosing that they have addiction, said McGinty. “We all know someone with diabetes or cancer, and in reality we all also probably know someone with addiction,” he said.

One of the biggest problems when it comes to news reporting on addictions is the circular nature of it, in which attitudes by policymakers and the public need to change in order to garner support for treatment, said McGinty. Once news articles publish stories about the benefits of locating a treatment center in a neighborhood, it will be easier to open such programs, she said. “Locating medication-assisted treatment facilities is a great example,” she said. “But without a policy response in place, it remains a scary, unfamiliar prospect.”

McGinty thinks coverage of addiction could change, but that change could come first on the prescription opioid side. “I think we have a unique window,” she said. “Prescription opioids are different from purely illicit addiction, in that people started with medications prescribed by their doctors so it started out being legal.” But when it comes to heroin and other illicit drugs, it may not be so simple. “The fact that we have people like Botticelli getting news coverage is a glimmer of hope,” she said. “But I think we are so ingrained to think of problems with drugs as a criminal justice issue rather than a medical problem that a wholesale change is going to take a long time.”

The study was funded by AIG as a “no-strings attached” gift through its charitable foundation arm, said McGinty. Originally the insurance company was interested in how it could reduce prescription opioid abuse in terms of claims paid for painkillers — that was not part of this study, but “prescription opioid addiction was affecting their bottom line, and it is an insurance company so it’s motivated by money,” she said. Another group at Johns Hopkins did that initial work, which was unrelated to this study.