By Maia Szalavitz
After Jillian Bauer-Reese created an online collection of opioid recovery stories, she began to get calls for help from reporters. But she was dismayed by the narrowness of the requests, which sought only one type of interviewee.
“They were looking for people who had started on a prescription from a doctor or a dentist,” says Bauer-Reese, an assistant professor of journalism at Temple University in Philadelphia. “They had essentially identified a story that they wanted to tell and were looking for a character who could tell that story.”
Although this profile doesn’t fit most people who become addicted, it is typical in reporting on opioids. Often, stories focus exclusively on people whose use started with a prescription; take this, from CNN (“It all started with pain killers after a dentist appointment.”), and this, from New York’s NBC affiliate (“He started taking Oxycontin after a crash.”)
Alternatively, reporters downplay their subjects’ earlier drug misuse to emphasize the role of the medical system, as seen in this piece from the Kansas City Star. The story, headlined “Prescription pills; addiction ‘hell,’” features a woman whose addiction supposedly started after surgery, but only later mentions that she’d previously used crystal meth for six months.
The “relatable” story journalists and editors tend to seek—of a good girl or guy (usually, in this crisis, white) gone bad because pharma greed led to overprescribing—does not accurately characterize the most common story of opioid addiction. Most opioid patients never get addicted and most people who do get addicted didn’t start their opioid addiction with a doctor’s prescription. The result of this skewed public conversation around opioids has been policies focused relentlessly on cutting prescriptions, without regard for providing alternative treatment for either pain or addiction.
While some people become addicted after getting an opioid prescription for reasons such as a sports injury or wisdom teeth removal, 80 percent start by using drugs not prescribed to them, typically obtained from a friend or family member, according to surveys conducted for the government’s National Household Survey on Drug Use and Health. Most of those who misuse opioids have also already gone far beyond experimentation with marijuana and alcohol when they begin: 70 percent have previously taken drugs such as cocaine or methamphetamine.
Conversely, a 2016 review published in the New England Journal of Medicine and co-authored by Dr. Nora Volkow, director of the National Institute on Drug Abuse, put the risk of new addiction at less than 8 percent for people prescribed opioids for chronic pain. Since 90 percent of all addictions begin in the teens or early 20s, the risk for the typical adult with chronic pain who is middle aged or older is actually even lower.
This does not in any way absolve the pharmaceutical industry. Companies like Purdue Pharma, the maker of Oxycontin, profited egregiously by minimizing the risks of prescribing in general medicine. Purdue also lied about how Oxycontin’s effects last (a factor that affects addiction risk) and literally gave salespeople quotas to push doctors to push opioids.
The industry flooded the country with opioids and excellent journalism has exposed this part of the problem. But journalists need to become more familiar with who is most at risk of addiction and why—and to understand the utter disconnect between science and policy—if we are to accurately inform our audience.
The innocent victim narrative
The reporters who called Bauer-Reese were not ill-intentioned in seeking the most sympathetic addiction stories; it is genuinely altruistic to want to portray those who are suffering in a way that is most likely to move readers and viewers to act compassionately. But such cases can have an unintended side effect: highlighting “innocent” white people whose opioid addiction seems to have begun in a doctor’s office sets up a clear contrast with the “guilt” of people whose addiction starts on the streets.
This is a result of racist drug policies that began decades ago. The war on drugs declared by Richard Nixon in 1971 was part of the Republican “Southern strategy,” which used code words like “drugs” “crime,” and “urban” to signal racist white voters that the party was on their side. When Ronald Reagan doubled down harsh law enforcement during the crack years, he merely intensified that strategy.
Rather than skeptically investigating, however, members of the media enlisted themselves as happy drug warriors throughout the 1980s and ’90s. Sensational stories focused on crack and its users as the cause of the problem, frequently ignoring that addiction hits hardest in communities facing high unemployment, de-industrialization, cuts in benefits, and loss of hope. In 1986, for example, promoting his documentary 48 Hours on Crack Street, CBS anchor Dan Rather intoned, “Tonight, CBS News takes you to the streets, to the war zone for an unusual two hours of hands-on horror.” Or here’s The New York Times in 1991, “Crack Hits Chicago, Along with a Wave of Killing,” and in 1994, “Crack Means Power, and Death, to Soldiers in Street Wars.”
Now that the problem is seen as “white,” however, socioeconomic factors and other reasons that people turn to drugs are more commonly discussed. The result is that today’s white drug users are portrayed as inherently less culpable than the black people who were caught up in the crack epidemic of the ’80s and ’90s.
Craig Reinarman, professor of sociology emeritus at the University of California, Santa Cruz, has documented biased coverage of addiction since before the crack era. “Now that the iconic user is white and middle class, the answer is no longer a jail cell for every addict, it’s a treatment bed,” he says. The biased coverage ends up perpetuating a public perception that some drug use, usually by African Americans, is criminal while other drug use, usually by white people, is not.
Criminalization still deeply affects our sympathy for people with opioid addiction. This headline recently appeared in the Times: “Injecting Drugs Can Ruin a Heart. How Many Second Chances Should a User Get?” Is that a question reporters would ask about people with diabetes who don’t follow their diet or those with heart disease who don’t exercise? In fact, the condition discussed in the Times article is not inherent to drug injecting, and the treatment of it doesn’t require limited resources like transplants do: it’s spread by unsterile syringes, which is a result of lack of access to clean ones, not addiction itself.
Often, stories focus exclusively on people whose use started with a prescription.
It’s important for journalists to understand that criminalization is not some sort of natural fact, and laws are not necessarily made for rational reasons. Our system does not reflect the relative risks of various drugs;legal ones are among the most harmful in terms of their pharmacological effects. With the exception of the legislation that resulted in the creation and maintenance of the FDA, our drug laws were actually born in a series of racist panics that had nothing to do with the relative harms of actual substances.
In order to do better, journalists must recognize that addiction is not simply a result of exposure to a drug, and that “innocence” isn’t at issue. The critical risk factors for addiction are child trauma, mental illness, and economic factors like unemployment and poverty. The “innocent victim” narrative focuses on individual choice and ignores these factors, along with the dysfunctional nature of the entire system that determines a drug’s legal status.
[To read the full story by Maia Szalavitz, go to The Columbia Journalism Review]
Maia Szalavitz is the author of the New York Times bestseller, Unbroken Brain: A Revolutionary New Way of Understanding Addiction and has covered drugs for over three decades for publications ranging from High Times to The New York Times. Along with leading addiction experts, she is helping to organize a group to provide journalists with better resources to improve addiction coverage.