Zohydro is a new, government-approved, ultra-pure form of the commonly used opioid painkiller, hydrocodone. And it has addiction experts so concerned, they’re trying to stop the drug from ever hitting the market. Currently marketed only in combination with acetaminophen (Tylenol) or aspirin, hydrocodone products are already the number one bestselling prescriptions in America, under brand names like Vicodin. And as Philip Seymour Hoffman’s recent death shows, the U.S. is now in the grips of an epidemic of addiction to prescription painkillers and heroin.
In a country where overdose has overtaken auto accidents as the number one cause of accidental death— and where opioids are implicated as part of the majority of these deaths— not surprisingly, addiction experts are worried about the impact of the new drug, which will go on sale this month.
Last week, Fed Up, a group of addiction doctors, rehabs and advocates for families affected by overdose, released a petition (PDF) asking the FDA to revisit its 2013 decision to approve Zohydro, noting that the agency’s own scientific advisory panel voted to reject it. “In the midst of a severe drug addiction epidemic fueled by overprescribing of opioids, the very last thing the country needs now is a new, dangerous, high dose opioid,” they write.
Zohydro is especially worrying because it contains no mechanism to deter misuse by snorting or injecting. Oxycontin, the drug blamed for creating the current opioid epidemic, has been reformulated to deter misuse: it now contains a substance that will block the high if the drug is taken by injection or snorting, rather than orally as prescribed. Studies show that this has reduced Oxycontin misuse (although unfortunately, much of the reduction seems to have been accomplished by addicts switching to heroin, hydrocodone products or other opioids).
Moreover, unlike Vicodin, Zohydro does not contain acetaminophen, which can potentially cause irreversible and sometimes fatal liver damage if taken in excessive doses. The inclusion of acetaminophen is thought to be another deterrent against misuse (although, again, it is not entirely clear how much this actually deters addicts and how much it simply adds to the damage that they do their bodies).
Nonetheless, clearly, in this environment, a drug like Zohydro is cause for concern. Unfortunately, however, the campaign against it may be exacerbating the very problem it hopes to prevent.
For example, here’s how headlines describe the drug: “Super Potent” “Genuinely Frightening” “10 Times More Potent Than Oxycontin” “America’s Deadliest New Drug?” If he were assigned it, Mad Men’s Don Draper couldn’t come up with campaign more suited to selling addicts and potential addicts on a new drug. If you are seeking the most intense high, these headlines tell you where to find it.
This problem has a long history and is the bane of drug prevention experts. Addicts overwhelmingly report that so called anti-drug songs like Lou Reed’s “Heroin” or supposedly cautionary memoirs actually pique their interest. Research on the topic goes at least as far back as the late 1950s and early 60s, when concern over a few children sniffing glue or otherwise misusing household products actually made a rare phenomenon into a national issue.
Curious teens saw headlines like “Plane Glue Gives Kids a Kick” and found stories that detailed what many of their peers were supposedly doing and precise information about how to do it. The articles spread the information from local pockets to a national consumer base. As the word spread, stories telling parents what products were worrisome taught kids which ones could produce a high. An account of this troubling history of inhalant use, published in Consumer Reports excellent and still highly relevant report on Licit and Illicit Drugs from 1972 was headlined “How to launch a nationwide drugs menace.”
Indeed, the current opioid epidemic itself was clearly exacerbated by media coverage: Alternet reported in 2001 that in Cleveland, there were more pharmacy robberies targeting Oxycontin after local media covered the problem than there were before. In what’s almost a parody of those “Ask Your Doctor” direct-to-consumer drug ads, heroin users started asking their dealers, Alternet reported:
“I never heard of the stuff until about a month ago, when one of my customers asked me about it,” one Cleveland heroin dealer said in mid April. “He showed me an article in the paper that talked about how everyone wanted to get hold of this shit, so I did a little checking and found some available.”
Research later backed these anecdotal accounts. A study published in PloS One in 2009 found that media reporting on opioid problems tended to precede increases in overdose deaths by about two to six months. And increased coverage explained 88% of the variance in death rate— an extremely strong correlation.
It’s not as though prevention experts are unaware of the problem: studies in the 80s and 90s found that “anti-drug” programs like the nation’s largest, DARE, either had no effect or increased drug use. When they sought to understand what elements were most dangerous, researchers discovered that prevention programs often increase children’s curiosity about drugs by describing their highs. Moreover, for thrill-seekers, a simple description of something as dangerous attracts rather than repels: taking risks is part of the excitement, not a reason to stay away.
Researchers also found that these programs suggest that “everyone’s doing it” and that this makes drugs more, not less, attractive. Modern prevention programs explicitly try to counter these impressions by having youth read survey data showing that, for example, college binge drinking occurs only among a minority of students. This “social norms” approach has had some positive results— but articles about “drug epidemics” send the opposite message.
So, what can reporters and advocates do to avoid exacerbating the problem they are supposedly trying to solve? It’s an incredibly difficult issue because drama gets clicks and advocates can’t work for change unless they convince the public, generally through the media, that their problem is not only worth addressing but large enough to matter.
Denying the risks that sensationalized drug coverage can sell the stuff it is supposedly decrying, however, won’t make them go away— any more than denial works in any addiction.