Those who watched Julia Louis-Dreyfus host Saturday Night Live this past weekend may be aware of the controversy created after the show featured a fake advertisement for a product called “Heroin AM.” It presents itself as a harmless ad for an over-the-counter medication, not unlike the ads you might see for NyQuil or DayQuil. Many were upset that the show seemed to make light of the rapid spread of opioid addiction throughout the United States, even featuring a line graph showing that heroin use has spread while “productivity has remained stagnant.” If you haven’t seen it, we’ll give you a couple of minutes to watch the ad yourself.[youtube https://www.youtube.com/watch?v=W-ZdQ0z5cLM]
While the ad may be satirical, it actually touches on a major point. Note that it does not play into addict personality myths, portraying suburban moms and dads rather than the unwashed, hoodie-wearing individuals that some consider the “typical” heroin user. With heroin spreading throughout social classes, this is incredibly accurate. And while heroin in particular continues to shatter class lines, opioid addiction in general has been doing the same. Prescription opioids are practically everywhere. In fact, CNN’s article on the SNL controversy points out that a PSA about opioid-induced constipation was even shown during the Super Bowl.
This PSA aside, many advertisers portray a world in which everyone is happier when they are on drugs. And while the advertised drugs may be intended for medical use, this sort of advertising has damaging potential. We’ll discuss this below, and we’ll attempt to provide a few examples of how these ads push the need for a medicated society. We will also discuss the things that SNL’s ad got right about the spread of opioid addiction. Before we do that, however, we would like to touch upon just how bad the spread of opioid addiction has become.
The Rise of Opioid Addiction
As CNN noted in their defense of the “Heroin AM” satire, heroin addiction has been increasing quite a bit in recent years. Since 2002, addiction rates have doubled while the rate of overdose deaths has seen a 286% increase, according to the CDC. Among the upper-middle class, rates have gone up by 60%. But many of those who make more than $50,000 per year did not start out as heroin addicts. It all began with prescription opioid addiction, and addicts simply graduated to heroin over time.
Many have called cannabis a “gateway drug,” but the truth is that any drug can be a gateway drug due to the very nature of addiction. As users imbibe more and more of a substance, their tolerance eventually goes up. As the drug holds less effect, their physical dependency stays the same. This will inevitably lead many substance abusers to seek a better high, one to which they have not become desensitized. As they shop around for new drugs and try various prescription cocktails, they put themselves in greater danger. Eventually, many who suffer from prescription opioid addiction may find their way to heroin.
Part of this may be due to the fact that certain opioid medications have become controlled more strictly. Doctor shopping is not as easy as it once was—not that this stops a fair number of addicts from doing it successfully. Furthermore, it can be difficult for some to find street connections for certain drugs. But those who look for street contacts to feed their opioid addiction are more than a bit likely to stumble onto heroin at one point or another. The problem has gotten so bad that, just earlier this year, CNN covered the Ithaca mayor’s plan to offer legal heroin injections.
This plan came under a lot of fire, the same fire that has been hitting life-saving medications such as Narcan. But in the event that heroin or opioid addiction cannot be stopped, the Ithaca mayor and the creators of overdose-preventing drugs like Narcan are doing everything they can to at least save lives. Opioids are often prescribed in cases when they are not truly necessary. And until this problem goes away, the rapid spread of opioid addiction is not likely to change any time soon. Of course, we still must discuss the role that advertising plays in the spread of the disease.
Addiction on the Small Screen
First of all, let’s take a look at that Super Bowl ad we mentioned for opioid-induced constipation. See if anything interesting stands out to you.[youtube https://www.youtube.com/watch?v=yr78_7Kip3Q]
What should have stood out to you here? More than anything else, it’s the time. Just over a minute long. If you watched this year’s Super Bowl, you might have noticed that even ads for blockbuster movies like Jason Bourne and Teenage Mutant Ninja Turtles: Out of the Shadows only ran about thirty seconds. This is because a thirty-second Big Game spot can cost as much as $5 million.
CommonHealth, a website run by Boston’s NPR station, analyzed this ad and the implications of its length. Obviously, a lot of money was put into this thing. The pharmaceutical companies who sponsored it would not have spent as much as they did if they did not have an expectation that a fair number of people watching the game would be regular opioid users. And this expectation is not unfounded. CommonHealth notes that the US Pain Foundation’s OIC page estimates approximately 8 million opioid users suffering from constipation. AstraZeneca, one of the companies that funded the ad, told CommonHealth that 40-80% of patients prescribed opioids for non-cancer pain suffer from OIC. This is terrible, but their estimate that 38 million patients are prescribed opioids is even more alarming. To be fair, many of these patients suffer from chronic pain that cannot easily be treated through other means. But the common belief that opioids in America are overprescribed seems to hold a bit of weight when considering these numbers.
It’s not the job of the above OIC ad to deal with opioid addiction in America, nor should it be. Their job is simply to cater to those who suffer from a very specific side effect of opioid medications. But according to White House Chief of Staff Denis McDonough, the ad has potential to cause harm. He responds that it could fuel opioid addiction, and he’s not wrong. While this ad may not cause opioid addiction, it normalizes the concept of prescribing opioid painkillers at the rate that they’re being prescribed.
Most people make fun of TV ads for medications due to the long lists of side effects, which has become more obvious now that they do not speed through them and instead take up more than half of the ad’s air time. But those who don’t want a drug because of its side effects may actively request a different one. And therein lies the problem—people going into the doctor’s office and requesting medication. Upworthy’s Parker Molloy says it best:
The reason we go into doctors’ offices is to have our symptoms diagnosed and treated. When we go in with a diagnosis already in mind (and with a brand name treatment to go with it), we’re effectively sidestepping the whole point of having doctors.
Advertising pushes self-diagnosis. And while many drugs advertised do not contain opioids, they still have the potential to spur opioid addiction by creating the sense that every symptom in existence must be treated with one drug or another. In Molloy’s article, she describes the AMA’s push for a ban on advertising last year, which was based partially on the fact that the $4.5 billion spent on direct-to-consumer advertising has raised drug prices and partially on the fact that advertising inflates demand for prescription drugs.
The spread of opioid addiction is an undeniable problem in the United States right now. Advertising a mostly harmless medication will not create opioid addiction, but these ads still inflate demand by causing many impressionable viewers to feel as if a trip to the doctor has been unsuccessful if they do not walk out with a prescription in hand. Virtually any type of pain may be treated with painkillers, and opioid addiction may be caused in someone who had heretofore shown no signs of addictive tendencies.
This is a problem that even SNL appeared able to identify. And while many felt that their “Heroin AM” ad made light of the rising rates of opioid addiction in the United States, it also contained a lot of necessary truths that some people may not have realized.
What the SNL Ad Got Right
As we noted before, SNL’s “Heroin AM” ad showed not only the rising rates of opioid addiction, but also the fact that these rates have been rising specifically among the upper and middle classes. Rich and poor alike have been seeing rising rates of opioid addiction and overdose deaths, and little has been done to solve the problem. Even the AMA’s proposed ban on advertising would not do anything to solve the problem if doctors continue to overprescribe opioid medications.
The ad contained a couple of other unfortunate truths as well. Note the segment in which the drug is described as being cut with caffeine and cocaine. This is a joke, meant to explain that this fictional brand of heroin will not cause drowsiness. But in truth, many dealers do cut heroin with other drugs. Not necessarily cocaine and caffeine, but fentanyl and heroin have been cut with one another quite frequently as of late. In fact, this is one of the reasons that the mayor of Ithaca wanted to offer legal injections. Not to fuel heroin addiction, but to save the lives of those who have suffered from it. When drugs such as these are mixed, the consequences can be incredibly fatal.
Also note that SNL’s ad depicts not only upper-middle class heroin users, but specifically those who appear to be rather high-functioning. We have talked about functional addicts and alcoholics before, those who are able to carry on their addictions while few of their family, friends and colleagues seem to notice. SNL’s ad appears at first to suggest no such thing exists, with the coach who is clearly on drugs in front of the children he is coaching. But then the ad ends with a heroin user getting onto a bus full of kids while showing no signs of drug use. Functional addicts do exist, and some of them suffer from opioid addiction. Family and friends may know that they abuse illegal drugs or prescription opioids, but may not say anything because it is not perceived as having a negative effect on them. Eventually, however, they will spiral. The main woman in SNL’s ad appears on the verge of hitting such a downward spiral, unbeknownst to her loving family.
These are all major concerns associated with the rise of opioid addiction. And with direct-to-consumer advertising fueling a nation in which it has become commonplace to walk into a doctor’s office and simply ask for medications, prescription drugs are becoming practically as accessible as over-the-counter medications. SNL’s satirical ad brings this to the forefront. Hopefully, this will lead to further discussion among American citizens about opioid addiction and other issues surrounding access to prescription drugs. In the meantime, contact us if you or anyone you know might be suffering from opioid addiction. Even if the matter has not yet graduated to heroin, there is no telling how long it will be before it does.