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New data released in early July show that the annual number of deaths attributed to drug overdoses has decreased for the first time in nearly 30 years. The drop was attributed to a decrease in deaths due to opioid painkillers. The news media greeted it as a triumph.
But during the late 1990s, when I began my medical training, the opioid narrative advanced by the news media was very different. Piece after piece told readers, including young doctors and medical students like me, that pain was under-treated and opioids were safe. Outlets championed a paradigm shift in the way we thought about pain relief. Pain joined body temperature, blood pressure, heart rate, and breathing rate as the fifth vital sign.
“Many doctors hesitate to prescribe opioids, which are heavily regulated because they can be used by addicts,” a pain-management specialist told the Associated Press in 2000. “But for people who have never abused drugs and have no history of psychological problems, hardly any become dependent on pain medication.” A 2001 US News and World Report story described OxyContin as a “safe, effective medication with few side effects,” and put the chances of addiction at one percent. In 2002, a New York Times story characterized physicians as “reluctant to prescribe” opioids, despite the fact that “in three studies involving nearly 25,000 patients with opioids who had no history of drug abuse, only seven cases of addiction arose from the treatment.” (The sources of those studies, and their funders, are not mentioned.)
I don’t remember whether I read these specific stories, but I certainly took similar messages from the dozens or even hundreds of others like them, published in respected, mainstream news sources. The credulous news coverage, which took as gospel the words of a few experts, helped change the feelings I, and my colleagues, had around prescribing opioid painkillers.
Since then, I’ve written hundreds of prescriptions for them. Given that we now know that between eight and 12 percent of patients prescribed opioids for chronic pain develop an addiction, I’ve probably fueled more than one problem.
ICYMI: Life-saving opioid addiction treatments get negative slant
TO BE FAIR, reporters describing the importance of opioids 20 years ago, and their dangers today, echo the consensus of the medical establishment. But covering the story without a healthy skepticism (or just choosing to cover it at all) can be dangerous. While the precise influence of news on doctors is difficult to quantify, a 2013 study by British researchers found that emotional, personal stories in the news impacted health-care providers’ attitudes toward medical care more than hard data did.
I’ve worked at a New York City academic medical center since 2007, where I see thousands of patients per year and participate in the education of hundreds of new doctors. Many of us consume news in small, easily digested bites like smartphone notifications, social media streams, and blogs—quick hits from trusted sources. That is difficult enough when it’s principled outlets like the Times.
But newer medical communications companies such as Medscape, a WebMD property which has received financial support from drug and medical-device companies, are now an increasingly significant part of those news diets. They exist somewhere between independent news and branded content. For a doctor scanning through articles, it’s hard to tell where editorial content ends and industry influence begins.
Residents are far more likely to listen to a podcast on the subway after a night shift than to read a book chapter or peer-reviewed journal article. One of my greatest fears as an educator is that the most popular podcasters in medicine will start accepting money to promote drugs or procedures.
LIKE MANY OF MY COLLEAGUES, I’ve curtailed my narcotic prescribing. Why? Probably because news coverage has once more changed my feelings. Coverage now frequently shows rapacious pharmaceutical companies, and an epidemic of wasted lives and pointless deaths. Those stories challenge me to reconsider those few Percocet I prescribed for back pain years ago, or that Vicodin for a toothache, and to remember seeing others arriving on EMS stretchers later, still and gray with overdose.
A recent study in the peer-reviewed journal Health Affairs suggested that those same patients may suffer one more indignity. It found that in states with high opioid overdose rates, local news coverage of medications like methadone and buprenorphine, which effectively treat addiction but have been associated with illegal diversion or the creation of new addictions, focused on the negative effects of such treatments. It’s quite possible this coverage means that some patients are being denied such drugs.
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