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.     

Under 2% of Medicaid‐covered youths get MAT after OD: Study

Fewer than one‐third of youths receive addiction treatment after an opioid overdose, and only one in 54 receive pharmacotherapy (methadone, buprenorphine or naltrexone), a study published in JAMA Pediatrics reports. The researchers urge interventions to link these youths to treatment after an overdose, and call for improving access to medications: methadone, buprenorphine, and naltrexone.     

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.     

Briefly Noted

We asked Jerry Rhodes, former top executive at CRC (now Acadia) and a leader in opioid treatment program management, what he thinks of methadone as a medication to be used in primary care to treat opioid use disorder (OUD), as some people — including former Office of National Drug Control Policy Director Michael Botticelli — recommended last year (see ADAW, July 16, 2018). “I take issue with that,” said Rhodes. “Methadone is a dangerous drug in an unregulated environment,” he told ADAW. Buprenorphine is prescribed this way, but “buprenorphine is a relatively safe drug, and methadone isn't,” he said. A veteran of many battles over methadone, including the near‐elimination of opioid treatment programs, Rhodes told ADAW that “you don't give unfettered access to methadone” to patients with OUD. “Be careful what you wish for” is his advice. This has the potential to cause harm, he said. “Only people who don't understand the history of its utilization would recommend this.”     

Long‐term use of methylphenidate continues to confer benefits

Patients continue to receive benefits from treatment for attention‐deficit/hyperactivity disorder (ADHD) with methylphenidate after long‐term use, researchers have found. Some patients may be withdrawn from the medication, however. Therefore, all patients should be assessed periodically to determine whether they continue to need the medication. The study, published in the American Journal of Psychiatry, was conducted because, while long‐term use of methylphenidate for children with ADHD is frequent clinical practice, its benefits are unclear. They looked at whether the medication remains beneficial after 2 years. Methylphenidate, a stimulant, has been controversial in some quarters because it is a controlled substance, However, the first‐line treatment for ADHD is psychostimulant medication, such as methylphenidate. How long children should take is is a question, but 60% of children receive stimulant treatment for ADHD for more than 2 years, and this is increasingly common, extending even into adolescence and adulthood. This is partly due to the awareness that ADHD is not a pediatric‐only condition. The study, “Continued benefits of methylphenidate in ADHD after 2 years in clinical practice: A randomized placebo‐controlled discontinuation study,” was published online May 21 by the American Journal of Psychiatry.     

Only 37% of police officers give naloxone to OD victims

According to a recent study, among police officers who responded to overdose calls in the last six months, only 37% administered naloxone on the scene, and 36% made an arrest, despite the fact that some of the states had a Good Samaritan Law — which protects people who make calls to police for overdoses — in effect. The study, “Knowledge, preparedness, and compassion fatigue among law enforcement officers who respond to opioid overdose,” is in the current issue of Drug and Alcohol Dependence. Most of the officers knew whether or not their state had a Good Samaritan Law, but only 26% knew that the law protects people on the scene from arrest.     

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 ).     

Briefly Noted

Vaping and nicotine replacement therapy (NRT) were equally effective at decreasing craving and withdrawal symptoms for smokers discharged from smoke‐free residential treatment for substance use disorder, a pilot study has found. The study, a randomized controlled trial to be published in Nicotine & Tobacco Research on behalf of the Society for Research on Nicotine and Tobacco in Australia, also found that retention was greater for the vaping group (96% at 12 weeks) than the NRT group (68%). For the study, 100 patients received telephone Quitline support and a 12‐week supply of either NRT or a vaping device. At 12 weeks, 14% of the vaping group and 18% of the NRT group report not smoking at all in the last seven days. The researchers concluded that their criteria for retention might have been too strict, and that “some leeway and looking at eventual success over the period people continue to engage with the aids would give a better picture of their long‐term potential.” There is a big movement to legalize vaping in Australia. A key point, however, is that patients readily engaged with smoking cessation after treatment when given the chance. “QuitNic: A pilot randomised controlled trial comparing nicotine vaping products with nicotine replacement therapy for smoking cessation following residential detoxification” by Billie Bonevski and colleagues is available open access, go to https://academic.oup.com/ntr/advance‐article/doi/10.1093/ntr/ntaa143/5889985 .     

Briefly Noted

Compared to light drinkers, heavy drinkers have brains that have less energy due to decreases in glucose metabolism, researchers at the National Institutes of Health have found. In a study published online last week in Nature Communications, the researchers combined measures of the left brain (activity) and the right brain (glucose consumption) to better understand the effects of alcohol on people. “The brain uses a lot of energy compared to other body organs, and the association between brain activity and energy utilization is an important marker of brain health,” said George F. Koob, Ph.D., director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), in a statement accompanying the release of the results. “This study introduces a new way of characterizing how brain activity is related to its consumption of glucose, which could be very useful in understanding how the brain uses energy in health and disease.” The research was led by Ehsan Shokri‐Kojori, Ph.D., and Nora D. Volkow, M.D., both of the NIAAA Laboratory of Neuroimaging. Volkow is also the director of the National Institute on Drug Abuse. “The findings from this study highlight the relevance of energetics for ensuring normal brain function and reveal how it is disrupted by excessive alcohol consumption,” said Volkow. “We measured power by observing to what extent brain regions are active and use energy,” explained Shokri‐Kojori. “We measured cost of brain regions by observing to what extent their energy use exceeds their underlying activity.” Using a group of healthy volunteers, researchers showed that different brain regions have different power and cost. They then looked at the effects of alcohol on these measures by assessing a group that included light and heavy drinkers, and found that both acute and chronic use affected brain power and cost. “In heavy drinkers, we saw less regional power, for example, in the thalamus, the sensory gateway and frontal cortex of the brain, which is important for decision‐making,” said Shokri‐Kojori. “These decreases in power were interpreted to reflect toxic effects of long‐term exposure to alcohol on the brain cells.” There was also a disruption of visual processing during acute alcohol exposure, and significant decreases in cost of activity during alcohol intoxication.     

Community,Ethnicity, and Class in a Changing Rural California Town*

Abstract This study investigates how community is constructed, maintained, and contested among diverse residents of a rural town in California's Central Valley. Drawing on observations, interviews, and archival material, I examine the way in which ethnicity and class play a significant role in recasting how community is organized and interpreted by Mexicans and long‐term white residents. In my field site, Mexicans have long been involved in (in)formal community‐making, yet long‐term white residents perceive a “loss of community” because social relations are no longer structured around an agrarian culture that at one time reinforced ties through volunteerism and interaction in local mainstream institutions. This article demonstrates the continual significance of place and interaction in defining community, but suggests that immigrants develop communities of need aimed at providing important social, emotional, and political support absent in mainstream society. Finally, this study also speaks of the competition for representation and respectability among rural residents developing a sense of belonging. “Community” is never simply the recognition of cultural similarity or social contiguity but a categorical identity that is premised on various forms of exclusion and constructions of otherness     

Saffron as good as methylphenidate in treating ADHD

Short‐term treatment with saffron — which comes from the crocus plant and is known to cooks as one of the most important and expensive ingredients of various dishes — is as effective in treatment of attention deficit hyperactivity disorder (ADHD) as methylphenidate, researchers have found in one small trial. The study, “Crocus sativus L. Versus Methylphenidate in Treatment of Children with Attention‐Deficit/Hyperactivity Disorder: A Randomized Double‐Blind Pilot Study,” was published in the February issue of the Journal of the American Academy of Child and Adolescent Psychopharmacology. Methylphenidate is a controlled substance, a stimulant with addictive properties.     

‘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.     

Analysis: The so‐called ‘Freedom Model’ of addiction treatment

The below comments were originally posted, in shortened form, on the Facebook Broken No More page. We asked the author to revise for ADAW, and he did. He refers to the article “Widespread Use of Medically Assisted Treatment (MAT) Has Not Resulted in Less Overdoses” (and we resisted the almost overwhelming temptation to change “less” to “fewer”). For the article, go to https://www.thefreedommodel.org/suboxone‐has‐not‐reduced‐deaths‐in‐the‐us/ .     

Briefly Noted

Last month, the federal Food and Drug Administration (FDA) warned that combining gabapentin or pregabalin with central nervous system (CNS) depressants such as opioids could result in serious breathing problems for patients with underlying respiratory problems, or in the elderly. New labeling will be required on gabapentin and pregabalin, the FDA said. There is less evidence supporting such a risk in otherwise healthy people, the FDA said in the Dec. 19, 2019, warning. Gabapentin, first approved in 1993, is not a controlled substance. It is approved to treat various conditions, including seizures, nerve pain, fibromyalgia and restless legs syndrome. Pregabalin, first approved in 2004, is Schedule V on the Controlled Substances Act, the lowest‐risk category of controlled substance. “With the evolution of the opioid crisis, getting ahead of new concerns or addressing those that are already evident requires examining signs of misuse and abuse as soon as any signal emerges,” said Douglas Throckmorton, M.D., deputy director for regulatory programs in the FDA's Center for Drug Evaluation and Research, in announcing the warning. “Reports of gabapentinoid abuse alone, and with opioids, have emerged and there are serious consequences of this co‐use, including respiratory depression and increased risk of opioid overdose death. In response to these concerns, we are requiring updates to labeling of gabapentinoids to include new warnings of potential respiratory depressant effects.” Drug manufacturers are also being required to conduct clinical trials to evaluate the abuse potential of all gabapentinoids, particularly when combined with opioids, said Throckmorton. The downside is that prescribers could inadvertently increase opioid use by not using these medications, Throckmorton acknowledged, saying “we do not want to unintentionally increase opioid use by turning prescribers away from this class of pain medications.” For more information, go to https://www.fda.gov/drugs/drug‐safety‐and‐availability/fda‐warns‐about‐serious‐breathing‐problems‐seizure‐and‐nerve‐pain‐medicines‐gabapentin‐neurontin .