The Kids Are All White: Examining Race and Representation in News Media Coverage of Opioid Overdose Deaths in Canada

Problematic opioid use in Canada is on the rise, and opioid overdose deaths now number in the thousands each year. While opioids have long been responsible for overdoses among certain demographics of Canadians, such as drug users on Vancouver's notoriously impoverished downtown Eastside, it is only recently that fatal overdoses have also claimed the lives of White, middle-class young people. This critical discourse analysis of Canadian news media examines the differences in racial representation in recent coverage of opioid deaths. I pay particular attention to the ways in which White opioid users are portrayed as innocent victims while other users, such as those from Indigenous communities, are often ignored or stigmatized as “addicts.” I draw on the work of Hall (1978; 2000) and Reinarman and Levine (1989; 2004) on the role of media in representing race and constructing drug scares, to frame the media narratives. I then discuss the Canadian government's current harm-reduction approach to the opioid crisis, as well as calls from Indigenous leaders for “culture as treatment.”     

NY AG ends Emergent's exclusivity for Narcan nasal spray

Narcan, the lifesaving opioid overdose reversal drug, has been the only naloxone spray allowed on the market due to an exclusivity agreement between the pharmaceutical company that owns it — Emergent BioSolutions — and the company that makes the spray device. This deal is ending thanks to New York Attorney General Letitia James, who has made it possible, via an agreement with Emergent, for other companies to use the patented, proprietary spray technology. Emergent, which bought Adapt, the creator of Narcan, will have to renegotiate these terms, James announced on Jan. 2. “Given the tragic, devastating effects of the opioid crisis, and the urgent need for additional drugs for the emergency treatment of opioid overdoses, my office will do whatever possible to ensure that there are no unnecessary impediments to the development of additional lifesaving opioid overdose reversal drugs,” she said. “I'm proud to announce that, starting today, additional companies will be able to gain access to these nasal spray devices. With more companies able to access this easy‐to‐use technology, our hope is that we can reduce the number of opioid overdose deaths across New York and this nation and save millions of additional lives.” A little history here: Adapt Pharma launched Narcan in February 2016, a year before the State Targeted Response (STR) grants were issued. Narcan is patented, but naloxone had been used for decades in the emergency treatment of opioid overdoses, by first responders and medical workers. In October 2018, in the middle of the lucrative STR (which no longer had to be 80% treatment) and State Opioid Response funding cycles, Emergent bought Adapt — for Narcan. Adapt had already entered into the contract with the nasal spray device manufacturer. Other pharmaceutical companies had been trying to develop a nalmefene overdose reversal drug using the device.     

Briefly Noted

Last week, a letter from Senators Edward J. Markey (D‐Mass.), Elizabeth Warren (D‐Mass.), Jeanne Shaheen (D‐N.H.), Dianne Feinstein (D‐Calif.) and Maggie Hassan (D‐N.H.) asked the Department of Health and Human Services (HHS) and the Substance Abuse and Mental Health Services Administration (SAMHSA) to immediately increase the patient cap — the maximum number of patients a physician can prescribe buprenorphine for — from 275 to 500. In addition, the letter requests that SAMHSA immediately process requests for emergency patient‐limit increases. “You can and should take immediate action to ensure that patients with OUD [opioid use disorder] are not denied the medication they need, do not exacerbate the strain on our nation's emergency departments and hospitals, and, most importantly, are not added to the COVID‐19 death count,” write the senators in their letter to HHS Secretary Alex Azar and SAMHSA Assistant Secretary Elinore McCance‐Katz, M.D. “We must empower our heroic health care providers to treat and save as many lives as possible in this time of crisis.” For the letter, go to https://www.markey.senate.gov/imo/media/doc/HHS%20SAMHSA%20Letter%20re%20Buprenorphine%20Prescriber%20Limits.pdf .     

NJ governor approves medical cannabis for OUD

Last week, Gov. Phil Murphy announced that New Jersey would remove prior authorization for Medicaid for medication‐assisted treatment (MAT) and would approve opioid use disorder as an eligible indication for medical marijuana. The moves, among several announced Jan. 23 in the state's efforts to combat the opioid epidemic, would increase access to treatment. Last year, more than 3,000 individuals in the state died from overdoses. “The opioid epidemic continues to devastate families and communities across our state,” said Gov. Murphy. “As we combat this crisis, it is critical that we use data‐driven, evidence‐based strategies to support individuals suffering from addiction and help them get on the path to recovery.”     

Kelly at CCSAD: AA works,but most severe patients need treatment

On Sept. 6, as the remnants of Hurricane Dorian were heading for Cape Cod, the Cape Cod Symposium on Addictive Disorders' (CCSAD's) plenary speaker John F. Kelly, Ph.D., Elizabeth R. Spallin Professor of Psychiatry in the Field of Addiction Medicine at Harvard Medical School and the founder and director of the Recovery Research Institute, gave the 1,100 attendees — many of them representatives of the treatment field — some welcome news: 75% of people who once had a problem with drugs and alcohol are now in remission. “Think about that,” said Kelly, who has become a mainstay of the speaker circuit in the addiction field. “This disorder has a good prognosis, despite, sadly, the opioid crisis.”     

Briefly Noted

Clayton Stafford died after using Vivitrol, and his family is suing Alkermes, the manufacturer, saying that the medication doesn't adequately treat addiction, compared to buprenorphine and methadone, and that the manufacturer knew this. In the lawsuit, California‐based law firm Lieff Cabraser alleges that Stafford, his parents and his treatment providers were misled into thinking Vivitrol was an appropriate treatment for his opioid use disorder. “Clayton Stafford's tragic death could have been avoided,” notes Lieff Cabraser partner Fabrice N. Vincent, who filed the lawsuit on behalf of the Stafford family. “The well‐reported defects in Vivitrol made Clayton's overdose a near‐foregone conclusion, and had the Staffords received accurate information about Vivitrol's risks and effective deficiencies from Alkermes, they would never have consented to its use by Clayton.” Naltrexone doesn't work to treat addiction and cravings, but just to block the effects of opioids, according to the lawsuit (and many others agree with this). “Because the patient's addiction is not adequately treated, the patient requires indefinite Vivitrol use to merely block the euphoric effects and keep the patient from seeking opiates,” Vincent said. “Patients therefore remain highly likely to relapse despite indefinite use of Vivitrol.” The lawsuit also makes note of Alkermes' direct‐to‐consumer marketing campaign, which extended into influencing the criminal justice system to use Vivitrol. Stafford had been mandated to use Vivitrol. Last year, the Food and Drug Administration issued a warning letter to Alkermes stating that its advertising did not state that stopping Vivitrol can lead to relapse and overdose, as is clearly stated by the label and package insert (see “FDA warns Alkermes about OD risk on Vivitrol ads,” ADAW, Dec. 16, 2019, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32566 ).     

Cannabis and alcohol use in young adults: Connections

People with HIV, as well as those who are uninfected, do well on long‐term treatment with opioids (methadone or buprenorphine), researchers have found. There is a strong dose‐response relationship between mortality (all causes), unnatural death and overdose, with the higher morphine equivalent daily doses having the best outcomes, according to the study, by Ajay Manhapra, M.D., and colleagues and published online Sept. 16 in the Journal of Drug and Alcohol Dependence. “Opioid risk mitigation approaches should be expanded to address the potential effects of higher dose on all‐cause mortality in addition to unnatural and overdose fatalities,” the researchers conclude in the abstract. For the study, there were 22,996 patients on long‐term treatment, 6,578 (29%) with HIV and 16,418 (71%) uninfected. Among 5,222 (23%) deaths, 12% were unnatural deaths and 6% overdoses. The study, “All‐cause mortality among males living with and without HIV initiating long‐term opioid therapy, and its association with opioid dose, opioid interruption and other factors,” also found that benzodiazepine use was associated with overdose.     

Braeburn asks FDA to revoke Sublocade's orphan designation

Braeburn, which makes Brixadi, a buprenorphine injection, has filed a Citizen Petition calling on the Food and Drug Administration (FDA) to revoke “orphan designation” — exclusivity — for Sublocade, Indivior's injectable buprenorphine. Saying that unless the FDA does this, no competitive buprenorphine opioid use disorder (OUD) treatment will enter the market until 2024, Braeburn said the Orphan Drug Act was enacted to treat rare conditions with small patient populations. In some cases, the act is utilized even if a large population could benefit, if there is “no reasonable expectation” of recovering developing and marketing costs. Indeed, orphan drug designation (ODD) was granted to Subutex (buprenorphine) in 1994, when Indivior's predecessor was the sponsor. Now the FDA has “grandfathered” the Subutex designation to Sublocade “simply because the developer of Subutex and Sublocade is the same,” according to a press statement from Braeburn released earlier this month.     

Philadelphia‐based harm‐reduction advocate joins CleanSlate

Brooke Feldman is well‐known to the Philadelphia world of drug users as a peer counselor active in harm‐reduction work. But starting this week, she will be Center Manager for two sites owned by CleanSlate Centers, a treatment program focused on opioid and alcohol addiction. Feldman has a master's in social work and is able to bridge the “street” world and that of the established treatment center—but acknowledges that there was a leap of faith involved in joining the treatment field.     

‘It’s so scary how common this is now:’ frames in media coverage of the opioid epidemic by Ohio newspapers and themes in Facebook user reactions

ABSTRACT

Deaths from opioid overdose in the US have increased five-fold since 1999. Ohio ranks second among states in drug overdose deaths, with more than 39 deaths for every 100,000 people. In light of this, opioid addiction and related issues have garnered substantial media attention. However, few studies have examined the content and framing of opioid-related media coverage or explored ways that audiences react to coverage of the crisis within their communities. This study attempts to fill this gap through an analysis of opioid-related posts and comments on the public-facing Facebook pages of 42 Ohio newspapers between 2013 and 2017 (N?=?397). Content analysis was used to identify frames in posted newspaper content and themes in comments. Four frames were identified in posted stories: (1) Awareness of the Opioid Epidemic and Affected Populations (34.0% of all posted content; n?=?135); (2) Programs, Policies, and Interventions (29.5%; n?=?117); (3) Crime, Punishment, Legal Cases, and Law Enforcement (28.2%; n?=?112); and (4) Narratives of Addiction and the Long Road to Recovery (8.3%; n?=?33). Analyses of Facebook user comments on posted newspaper content revealed five themes: Emotion and Support, Choice and Responsibility, Disease and Treatment, Worthiness, and Attention and Action. Findings indicate both the intensive and diverse efforts of newspapers to cover the epidemic as well as the varied reactions of community members to opioid use and addiction.     

Pregnant Women's Experiences of Crisis Pregnancy Centers: When Abortion Stigmatization Succeeds and Fails

There is broad consensus that abortion is stigmatized, but the role of interpersonal interaction in this process is underspecified. I examine interviews with 25 women in the United States who visited crisis pregnancy centers (CPCs)—antiabortion organizations that offer one‐on‐one “prolife counseling”—for how and when interactions matter for abortion stigmatization. I identify two primary ways CPC counselors stigmatized abortion and describe variation in their impact: counselors' efforts were “successful,” were misrecognized as ideologically‐neutral, or were resisted. The findings demonstrate the importance of women's current consideration of abortion and preexisting beliefs for understanding how interpersonal interactions contribute to abortion stigma.     

In the states

The Coalition of Medication‐Assisted Treatment Providers and Advocates of New York State (COMPA) issued support and further encouragement to New York legislators last week for the passage of a package of bills to combat the opioid addiction epidemic by increasing access to medication‐assisted treatment (MAT). “We applaud the Senate and Assembly passing A2904 Quart/S4808 Harckham, which eliminates prior authorizations for all MAT medications for commercial insurance policies,” said Allegra Schorr, president of COMPA. “This will increase access to treatment and reduce barriers for delivering care.” She added, “We urge the passage of A7246 Rosenthal/S5935 Harckham, which provides critical access to all medications to vulnerable Medicaid populations during this opioid crisis. Moreover, in order to ensure that all New Yorkers can access care, we urge the state to implement the policy outlined in A833 Rosenthal/S2161 Bailey that would establish a patient‐centered MAT program for incarcerated individuals in jails and prisons, and COMPA supports A972A Rosenthal/S4643A Harckham, which would prohibit copays during the course of treatment at an opioid treatment program.” COMPA is a nonprofit membership organization dedicated to treating addiction through the use of pharmacotherapy as a part of a comprehensive biopsychosocial approach to treatment. COMPA's program members include both opioid treatment programs and office‐based opioid treatment providers. COMPA is the New York state member program of the American Association for the Treatment of Opioid Dependence.     

The SIF debate: Lines drawn with Rosenstein op‐ed,but truth may lie in the middle

The federal Department of Justice is not going to allow supervised injection facilities (SIFs) to go forward, with Rod J. Rosenstein, deputy attorney general, drawing a clear line in the sand in an Aug. 27 op‐ed in The New York Times ( https://www.nytimes.com/2018/08/27/opinion/opioids‐heroin‐injection‐sites.html ). “Advocates euphemistically call them ‘safe injection sites,’ but they are very dangerous and would only make the opioid crisis worse,” he wrote, calling them “B.Y.O.D.” facilities (for “bring your own drugs,” which they are). In SIFs, people can be revived by naloxone if they overdose; if they inject alone, which happens often, they can't.     

How does naloxone distribution relate to opioid overdose deaths?

The $64,000 question — or however much money has been spent on naloxone, the lifesaving medication that rescues opioid overdose victims — is whether the distribution of the medication has an effect on overdose deaths.     

Views on medication's role in treatment begin to converge amid deadly epidemic

In “Intervention stigma: How medication‐assisted treatment marginalizes patients and providers,” a researcher writes about one of the biggest paradoxes facing those treating and being treated for opioid use disorders (OUDs): the fact that the “gold standard” for treatment — methadone and buprenorphine — subjects both providers and patients to stigma, both within and outside addiction treatment communities.     

TMZ shifts blame from police to drugs in Floyd death coverage

Last week, the Hennepin County Medical Examiner released the cause of death report of George Floyd, and when celebrity website TMZ got hold of it, it started what seemed like blaming the victim. Floyd's murder by the police was followed by days of protests around the country. The Minneapolis police officers involved — one choked him to death with a knee on his throat while the others watched — were fired. But TMZ's headline said “M.E. says he died from heart attack, had fentanyl…,” and the article went on to interpret the death certificate as follows: “In other words … he suffered a heart attack while they were arresting him, and that complicated their efforts to subdue him. The report says George had fentanyl in his system, and they also found signs of recent methamphetamine use. It also says his manner of death is homicide.”     

Is counseling ‘required’ with medications to treat opioid use disorder?

In “No Strings Attached: More Opioid Addicts Get Meds Without Talk Therapy,” an article by Beth Schwartzapfel of the Marshall Project published in USA Today May 9 ( https://www.usatoday.com/story/news/investigations/2019/05/09/opioid‐crisis‐drugs‐no‐therapy/1131110001/ ), both sides were excellently reported. Kenneth B. Stoller, M.D., longtime methadone researcher from Johns Hopkins, was quoted as saying that medications without any talking is “selling patients short.” Some Twitter participants immediately charged that Stoller was kicking patients off medication if they weren't participating in counseling (which he doesn't do and the article doesn't say he does), and a protracted debate on Mother's Day led us to ask Stoller himself — who does not tweet — to respond. We copied and pasted the comments so he could see them. His response is below. (To see the Twitter thread, go to https://twitter.com/ADAWnews/status/1127175604959436800 .)