Man Trapped in a Billboard
This article, in a slightly edited form, first appeared on Pain News Network on July 13, 2019.
The mission of The Partnership for a Drug-Free New Jersey (PDFNJ) is to reduce substance use and misuse in New Jersey. They have received more than 200 advertising and public relations awards. Much of their work is laudable, but their “trapped in a bottle” campaign, which spreads misleading and harmful information, misses the mark.
The PDFNJ-sponsored giant digital billboard of a man trapped in an opioid bottle looms over Times Square. It warns viewers, “In just 5 days, opioid dependency can begin.” The ad talks about dependency, but it conflates dependency with addiction.
Physical Dependence vs. Addiction
Physical dependence is a process that starts with exposure to the first pill. Discontinuance of an opioid may lead to withdrawal — but the hyperbolic ad can easily be mistaken to be about addiction rather than dependency.
Dependency is a normal neuroadaptation that takes place when certain brain receptors are exposed to drugs, including opioids. These drugs change the structure and function of a receptor with continual exposure, and that can result in physical dependence. If the drugs are abruptly stopped, that can cause withdrawal.
Using opioids for as little as five days will almost never induce withdrawal. And even if withdrawal occurs after taking a short course of opioids, it does not mean the person is addicted or has an opioid-use disorder.
The “five days” concept is meaningless except insofar as it spreads unhelpful myths about opioids. I have prescribed opioids to thousands of patients and have never seen a patient experience withdrawal when stopping within a week or even two. Managed properly, the overwhelming majority of patients experience no negative effects from dependency.
Addiction, on the other hand, requires much more than simply ingesting a pill, and it does not occur in any specific number of days. The development of this disease is a process that involves multiple factors and occurs over time.
It is important to remember that addiction is not resident in the drug but, rather, in human biology. Exposure to an opioid is necessary but, by itself, it is insufficient to cause the disease.
For people who develop an addiction, opioids provide a reward, and the brain seeks to repeat the pleasurable experience. For a vulnerable person, one pill can be so rewarding that it drives pleasure-seeking behavior that can lead to addiction. But that does not happen in five days or on any other timetable.
This is not the first time PDFNJ has created over-the-top digital billboards to scare consumers away from using prescription opioids. A 2016 PDFNJ billboard intended to frighten parents asked: “Would you give your child HEROIN to remove a wisdom tooth?” This melodramatic question was followed with, “Ask your dentist how prescription drugs can lead to heroin abuse.” The innuendo is neither educational nor informative.
The Media’s Inaccurate Portrayal of the Opioid Crisis
It’s understandable that an advertising agency would have trouble accurately conveying the problems of drug dependence and addiction when the media, too, often has difficulty communicating the facts.
In a recent WPIX article describing the “Man Trapped in a Bottle” campaign, Mary Murphy writes, “The Centers for Disease Control [CDC] reported that drug overdoses killed more than 72,000 people in the United States in 2017, a new record driven by the deadly opioid crisis.”
Murphy stated how many people died of all drugs to illustrate the harm of prescription opioids. But prescription opioids are involved in less than 20,000 deaths. If she wanted to use a large number, she should have said there were 150,000 deaths from substance abuse in 2018. This would include alcohol-related deaths. Of course, alcohol delivers its poison in a bottle, too.
Murphy writes that a large percentage of drug overdoses can be attributed to heroin or fentanyl. Indeed, these are major sources of opioid deaths, but she fails to point out that neither heroin nor illicit fentanyl are prescription opioids. Nor are they commonly found in a bottle. Again, her implication is that prescription opioids are at the heart of this crisis.
Concepts Video Productions, which is based in Towaco, New Jersey, produced the digital billboard. “Each year, we select a pro-bono project that will impact the world,” said Collette Liantonio, creative director of the production company.
Liantonio’s project, however, may do nothing for the world besides demonstrate how imperfectly most people understand the reason for the drug crisis in America, and reinforce prevalent myths about it. Perhaps Concepts Video Productions should consider creating a billboard that shows someone who is unable to find a job that pays a decent wage, and seeks to escape poverty and hopelessness with drugs. Economic and social woes, rather than prescription drugs, are at the core of our country’s drug crisis.
Fear Is Not the Answer
Using fear to solve the drug crisis will never be successful.
Moreover, knowing a drug’s potential to lead to physical dependence or addiction will not prevent anyone from seeking a psychological experience to escape painful life experiences. The answer is to address the emotional and physical needs that create dependency or addiction in the first place.
Sunday, July 14, 2019
Ever since the well-intended, but horribly misguided attempts by the CDC with of course, help from the wonderful, always-misguided, DEA, as well as pumpkin head signing off on ridicules bills regarding Opioid-related dosing, etc., used to just cause me unyielding, major frustration, all, in addition to my daily, unrelenting pain. I’m now well beyond frustration and am just downright MAD! I recently took my father to his pain doctor. This doctor had previously prescribed 40mg Oxycontin ER, (1 every 12 hours, although they only last 4 hours, and I can’t guarantee that the same thing happens to me, and many others, for many ER medications. 12 hours is a joke!) along with one (1) 10 mg dose of Oxycodone/Acetaminophen 10/32 mg, allowing for only a total of 4 pills per day! Yep that’s 2 doses for an entire 24-hour time frame for non-stop breakthrough pain. I took my father in to this Pain Doctor because his PCP refused to be responsible for his pain meds. Nevertheless, because the 40mg Oxy ER’s were not working at all for his pain, nor were the Percocets for short-acting, breakthrough meds working either. So, we were there to get an increase to try 60mg Oxy ER, and an increase in the number of breakthrough meds he could take daily. This was the first time ever that I actually got into an argument with any doctor to the degree it did. The 40mgs didn’t work, so what did the doc do? He lowered them to 30mgs! The breakthrough meds weren’t working at the current dosing either, so we were asking for an increase in the dosing of the current med, or another breakthrough pain med of a higher strength or more of a daily allowance. So, what did the doctor do? He took my father off of any/and or ALL breakthrough pain meds entirely, with absolutely no replacement for his breakthrough pain at all! After coming out of the ‘shock’ of his intentional cruel and harmful actions, I finally got to the point of asking what he was basing this dosing nonsense on? He refused to answer me, and was downright mad that I had the audacity to question him at all! There has been another visit since that one and he still will not provide ANY RATIONALE for his cruel and unusual actions. I told him that I believe he was basing his actions, at least in part, on the insane CDC ‘guidelines-taken-as-mandates’ by many doctors, pharmacies and manufacturers, but their mistakes in interrupting the original guideline sent out by the CDC were addressed in the letter that the CDC FINALLY sent out some 3 years after the start of this national fiasco. I asked if he had read the recent letter from the CDC, although very late in coming, it was released this past April. He again, refused to answer my question. We both knew that he, nor his PA’s had read it (after similar dealings with them,) and I told him (paraphrasing of course) what the jest of the letter had stated, including the fact that the 90 mg Morphine Equivalent dosing recommended were for NEW PATIENTS ONLY, and not longtime, chronic pain patients, who had already been on much higher doses. Rather than addressing that FACT, he just even madder, raised his voice to me, and especially so, after pointing out points of the April letter and that I totally disagreed with his suggested course of action with regard to my father’s pain medications. He said, “You can disagree all you want, but I AM THE DOCTOR AND I MAKE THE FINAL DECISION!” Ah, that wonderful “God Complex” is still alive and well! I could not make the last pain doctor appointment with my father, so my husband went with him. I sent a letter with my husband to give this uneducated pain doctor, citing FACTS, and I told him that his course of action with my father’s pain medication was nothing short of cruel. According to my husband, the doctor was ‘fine’ when entering the room reading my letter, until he finished it and then he was beside himself with ANGER. That’s when doc lost it again, and reaffirmed that he is the almighty, all-knowing “GOD,” whoops, meant “Doctor” and what he decides – is what is going to happen. Nope, not good enough! Not anymore! The days of rolling over and allowing any of these misguided and “God Syndrome’ personalities, take Chronic Pain Patients substantially down in dosing and strength, and/or entirely off of their long term pain medications for both Extended Release and Short-Acting medications, which can only result in excruciating pain, with thoughts or actions of suicides for no good reason, or rationale, can no longer be tolerated! I am writing the Medical Board about the actions of this particular doctor, as well as my continued correspondence with all of my political representatives about this issue. I am in the process of getting my father on Palliative Care, with no medication dosing limit, so that he has any “quality of life” before he passes away. All he does is sit on his couch day in, and day out, in horrible pain. The highlights of his days are figuring out the best method of getting from the couch to the kitchen or the bathroom, with the least amount of pain as possible. So far, nothing has been successful. In 2019 we have the medications, we have the knowledge, we have the ability to curb a huge amount of each individual’s pain level, and to just not use it, because of the ever-increasing overdoses from STREET DRUGS OF FENTANYL AND HEROIN, with even more deaths from suicides from Chronic Pain Patients who have lost most, if not all, access to legitimate pain medications, just cannot go on indefinitely. My father’s story is but one small blip compared to the millions of stories out there, along the same lines. WE MUST UNITE! THERE IS POWER IN NUMBERS, SO WE MUST COME TOGETHER TO FIGHT THESE INJUSTICES AS A STRONG WELL-EDUCATED (on this issue) GROUP! I am most happy to join any pre-existing groups, or will start one myself. Dr. Lynn Webster has been a strong supporter of our cause, and is the one who keeps me abreast of much of what is going on medically and politically regarding this issue. It would be helpful to have at least a few members of the medical and political communities. The better educated of these industries see this CDC problem for what it is, along with all of the media inaccuracies, and much more. Hopefully, Dr. Webster would be a resource to contact with specific questions, of even consider becoming a member of our group. With the millions of Chronic Pain Patients in this country, the possibility of getting a large group is there! My dear fellows Chronic Pain Patients; if you are finally to the point where ‘enough is enough’ and you’re tired of being treated like you are ‘drug seeking,’ had your pain meds lowered, or taken away altogether, were abandoned by your doctor regarding your pain medications, or any other post CDC-guideline issues, just to get your regular pain meds – or someone close to you is going through the same insanity, then we need you, your support and participation. SOMEONE HAS TO DO SOMETHING! Please feel free to email me at the address listed for me, and indicate that you want to join, I will figure out, what I believe is the next step based upon the number of members we have and I will share all information and calls for votes on some of the first things we need to do to turn this idiocy back around! Sorry for the length and I truly thank you for your time and membership consideration! WE CAN DO THIS!
Connie,
I couldn’t see the email address, but have had the same thoughts. I’ve been out of work because my pain meds became unreliable, then just impossible to fill after my previous doctor moved out of state, so that I was the dreaded “New Patient”!
Please find me on Twitter at DanielAndrade74 so we can discuss. The CDC acknowledges there are 50 million chronic pain sufferers in America. That is one sixth of America, and a few short of the 62-65 Million votes a President gets. We can swing every election next year if we join together and our friends and family support us.
Be well,
Daniel
Research tells us that these kinds of advertisements are not helping instead they are doing more damage. What is really horrifying is the use of a real public health crisis, as a marketing tool. If we go back to 1996 , the year that TV ads for pharmaceuticals become legal ,and the same year that Perdue began their opiate marketing campaign, we are 22 years out. Wee have seen the abject failure of every agency that was supposed to protect public health. The FTC failed to regulate in content marketing, or the use of serious public health issues, as marketing, and propaganda tools.
A look at the history of the so called opioid crisis, show how industry greed, regulatory capture, unregulated marketing, and money in politics, created this so called crisis. Even now they continue to misdirect the public and blame patients and physicians. They do not want any threat to industry profits and patients and physicians are easy scapegoats for the ongoing corporate greed. These industries had to create a culture of denial about pain, about childhood trauma and replace facts with beliefs.
No one is scrutinizing the effect of corporate medicine and pharma lobbyists on our healthcare. Pharma. the insurance companies,and big healthcare providers, promoted a 30 day supply of opiates, because it was profitable for pharma and cost effective for health providers. Insurance did not want to pay for follow up appointments, and physicians were stretched too thin, to see a patient who needed follow up for pain. At the same time these industries covered for medical mistakes and the fact that many American wait months or years for medical and dental appointments. They cleverly compare prescribing rates with other developed nations, where people actually have real accesses to healthcare. People in those countries do not let their teeth abscess, because they can’t afford a dentist like here in the US. In other developed nations, people do not have to return to work while injured, and then take opioids to function.
Other developed nations have a financial incentive to limit pharma advertising, and deceptive health marketing. Here in the US this costs us billions of dollars, yet the media does not cover any of that. Opioids became a good fear based marketing tool for content marketers, and targeting people with pain is profitable. Over the last 22 years, pharma marketed dangerous and ineffective drugs as replacement for opioids, and the industry and media covered up the facts to protect industry profits. CMS was not allowed to track any of this, just like they were not allowed to track other failures of the healthcare system. Facts and data could cut into profits. No ER tracked the number of patients who overdosed on these “replacement” drugs or even the number of NSAID deaths or admissions. Steroid injections, and pain pumps were really profitable even though patients died, or ended up paralyzed or in worse pain. The FDA hid reports of device failures to protect industry profits, while patients died or were subjected to multiple surgeries. Since the FDA hid the adverse incident reports, Medicare did not track this either. Physicians that took device industry money, hid the information from patients too, even blacklisting them, to hide the corruption.
This is all about money and profits, people want someone, or something to blame, and this kind of deceptive advertising does just that. They targeted people with pain, and sick people, instead of questioning how much money their elected representatives took from these industries, to protect them. We see the most blatant corruption normalized in the hearings on prescription drug pricing. All we have to do is ask, Who benefits, from and add like that. People are dying from illegal drugs,a and stolen or black market pharmaceuticals, but the advertisement focuses on patients. Every day there is another article about opiates in the newspaper, each one misreports the facts in order to appeal to readers. Content marketers/journalists know very well that fear is good for marketing, and with no regulation of misleading medical advice, or this kind of marketing, it is getting dangerous. No one is researching the unintended consequences, there is no money from these industries for any of that.
People are getting Hepatitis C, AIDS, and infections from dirty heroin needles, but lets look at an outlier, a patient taking prescription opiates, and under a physician care. People stole prescription medications out of peoples medicine cabinets, and some took them and died the very first time. They combine them with alcohol, but there are no adds for any of that. The alcohol lobby would not approve, it could cut into profits. The drug cartels are selling fentanyl pills they branded as Oxy’s to increase sales, but the media and content marketers are not discussing that. There is a reason they are targeting patients, it is just more profitable. New patients in fear of opiates will demand expensive, useless, and dangerous alternatives, which are all under patent. Physicians will turn away patients with pain, even if the pain is an indicator of cancer, and they can claim it was because they were seeking opiates, but in reality they were just troublesome or unprofitable. Patients with those failing medical devices experiencing pain, can be coded as having Opioid Use Disorder, and denied treatment. Many of those patient turned to alcohol, when their medical device implants failed, and chose to drink themselves to death, but no research was done on that either.
We live in a country where alternate facts can be really profitable. It is all about deception and distraction. These advertisements make it appear that something is being done, as the opposite happens. They feed into the culture of denial, and cruelty by deliberately targeting patients, instead of the corrupt industries, that created this. Research tells us that adverse childhood experiences can lead to addiction and other problems, yet there is no move to identify of prevent any of that. The US is in an epidemic of despair, and even that is covered up by these ads. Every single day the public is exposed to lies, propaganda, and misinformation, to create the level of denial we are seeing.
There used to be laws and regulations on health related marketing, now they can sell anything even if they mislead and stigmatize. The Anti Vaxx movement is still profitable along with marketing E Cigs to kids,as long as it is framed as health related.