Write a critical summary (250-word paragraph summary, 250-word paragraph evaluation, for 500 words total or 1.5 – 2.5 pages double spaced) for the article “Representations of Oxycontin…”
12816_whel.indd Pain Res Manage Vol 16 No 4 July/August 2011252 Representations of OxyContin in North American newspapers and medical journals Emma Whelan PhD1, Mark Asbridge PhD2, Susan Haydt MA1 1Department of Sociology and Social Anthropology; 2Department of Community Health and Epidemiology, Dalhousie University, Centre for Clinical Research, Halifax, Nova Scotia Correspondence: Dr Emma Whelan, Department of Sociology and Social Anthropology, Dalhousie University, 6135 University Avenue, Marion McCain Arts and Social Sciences Building, Halifax, Nova Scotia B3H 4P9. E-mail
[email protected] The story is a familiar one to readers of Pain Research & Management. OxyContin (Purdue Pharma, Canada), a controlled- release for- mulation of the opiate agonist oxycodone, was approved for medical use in the United States (US) in 1995, and then in Canada in 1996. The drug was considered to be a breakthrough, both for its ability to provide sustained relief from pain and because both its manufacturer and the US Food and Drug Administration expected that its extended- release formula would make it less prone to abuse than other opi- oids (1). Within five years, the popular and medical presses began to report the use of OxyContin as a street drug, particularly in rural com- munities in the eastern US, earning it the nickname ‘hillbilly heroin’. Since then, OxyContin has been represented regularly as a devastating social problem in Atlantic Canada and many other economically dis- advantaged, rural regions of North America. However, media representations of OxyContin as primarily a drug of abuse have not gone unchallenged. For instance, the Canadian Pain Society (CPS) issued a press release in August 2004 (2) criticizing the inaccurate and one-sided media coverage of the OxyContin problem: Most of these stories have failed to mention that the vast majority of people, who use these medications properly, greatly benefit from reduced pain. As a result of this recent media coverage, all Canadians who take opioid analgesics to treat chronic pain have been stigmatized and made to feel like they might be doing something wrong…Patients with moderate to severe pain from injuries, cancer or other medical conditions should not be denied medications that can provide needed relief, nor should they feel afraid or ashamed to take the medi- cation they need because these legitimate products have become stigmatized as ‘drugs of abuse’. Another CPS news release about the biases in media reporting, specifically by the CTV program W5, followed. Indeed, since the advent of the crisis, we have witnessed a flurry of consensus docu- ments, media interviews and best practice guidelines from pain soci- eties across North America. However, efforts to reframe the use of opioids for pain as an appropriate therapeutic option in properly screened patients seem to have had limited impact because recent Canadian headlines pertaining to the drug have expressed familiar themes: “Study links OxyContin to increase in deaths” (Toronto Star, December 7, 2009); “Newborns going through withdrawal from moms’ painkiller abuse” (Vancouver Sun, January 18, 2010); “Oxycontin ORigiNAl ARtiCle ©2011 Pulsus Group Inc. All rights reserved E Whelan, M Asbridge, S Haydt. Representations of OxyContin in North American newspapers and medical journals. Pain Res Manage 2011;16(4):252-258. BACkgROuNd: There are public concerns regarding OxyContin (Purdue Pharma, Canada) and charges within the pain medicine commu- nity that media coverage of the drug has been biased. OBJECTIVE: To analyze and compare representations of OxyContin in medical journals and North American newspapers in an attempt to shed light on how each contributes to the ‘social problem’ associated with OxyContin. METHOdS: Using searches of newspaper and medical literature data- bases, two samples were drawn: 924 stories published between 1995 and 2005 in 27 North American newspapers, and 197 articles published between 1995 and 2007 in 33 medical journals in the fields of addiction/ substance abuse, pain/anesthesiology and general/internal medicine. The foci, themes, perspectives represented and evaluations of OxyContin pre- sented in these texts were analyzed statistically. RESulTS: Newspaper coverage of OxyContin emphasized negative evaluations of the drug, focusing on abuse, addiction, crime and death rather than the use of OxyContin for the legitimate treatment of pain. Newspaper stories most often conveyed the perspectives of law enforce- ment and courts, and much less often represented the perspectives of physi- cians. However, analysis of physician perspectives represented in newspaper stories and in medical journals revealed a high degree of inconsistency, especially across the fields of pain medicine and addiction medicine. CONCluSION: The prevalence of negative representations of OxyContin is often blamed on biased media coverage and an ignorant public. However, the proliferation of inconsistent messages regarding the drug from physicians plays a role in the drug’s persistent status as a social problem. key Words: Media; Opioids; OxyContin; Public opinion; Social issues; Sociology les représentations de l’OxyContin dans les journaux d’Amérique du Nord et les revues médicales HISTORIQuE : Le public s’inquiète au sujet de l’OxyContin (Purdue Pharma, Canada). Dans le domaine de la médecine de la douleur, on croit que la couverture médiatique du médicament est biaisée. OBJECTIF : Analyser et comparer les représentations de l’OxyContin dans les revues médicales et les journaux d’Amérique du Nord afin de jeter la lumière sur la manière dont ces médias contribuent à la croyance selon laquelle l’OxyContin s’associe à un « problème social ». MÉTHOdOlOgIE : Au moyen de recherches dans les bases de données des journaux et des publications médicales, les auteurs ont extrait deux échantillons : 924 articles publiés entre 1995 et 2005 dans 27 journaux d’Amérique du Nord, et 197 articles publiés entre 1995 et 2007 dans 33 revues médicales dans les domaines de la toxicomanie, de la consommation abusive d’alcool et de drogues, de la douleur et de l’anesthésiologie ainsi que de la médecine générale et de la médecine interne. Ils ont procédé à une analyse statistique des éléments centraux, des thèmes, des perspectives et des évaluations de l’OxyContin présentées dans ces textes. RÉSulTATS : La couverture journalistique de l’OxyContin faisait ressortir les évaluations négatives du médicament, s’attardant sur la consommation abusive, la toxicomanie, les délits et les décès plutôt que sur l’utilisation de l’OxyContin pour le traitement légitime de la douleur. Les journaux traitaient surtout des perspectives de la répression criminelle et des tribunaux et moins de celles des médecins. Cependant, l’analyse des points de vue des médecins représentés dans les articles de journaux et les revues médicales a révélé un taux élevé de contradictions, notamment dans les domaines de la médecine de la douleur et des troubles de toxicomanie. CONCluSION : La prévalence des représentations négatives de l’OxyContin est souvent imputée à une couverture médiatique tendancieuse et à un public ignorant. Toutefois, la prolifération de messages contradictoires au sujet du médicament de la part des médecins contribue au statut persistant du médicament à titre de problème social. OxyContin in newspapers and medical journals Pain Res Manage Vol 16 No 4 July/August 2011 253 blamed for town’s home-invasion trend” (Toronto Sun, January 29, 2010); “Man sold Oxy to supply his own habit” (Sudbury Star, January 26, 2010). The present article reports the first phase of a four-year study of the problematization of OxyContin, and the responses of pain and addic- tion experts and pain activists to that problematization. The study was funded by the Nova Scotia Health Research Foundation; no funding was provided by the pharmaceutical industry. We present quantitative data regarding North American newspaper representations of OxyContin from 1995 to 2005 – a period that began with the intro- duction of this much-heralded drug and ended with several waves of public concern about its abuse. The story is ongoing, but these data paint a picture of the formation and initial responses to the crisis. Our data demonstrate that the concerns of the CPS, in 2004, regarding one-sided media coverage were well founded. However, we questioned why this media coverage was so one sided. To that end, we also present quantitative data regarding the coverage of OxyContin by medical journals from 1995 to 2007. These data suggest that the broader med- ical community was sending highly variable, inconsistent messages to the public and, consequently, to the news media in its representations of OxyContin. This lack of consistency may have fuelled the media circus surrounding the drug, and contributed to the fear and uncer- tainty surrounding its use and the use of other opioids in the treatment of pain – a legacy that the pain medicine community is still dealing with today. Other authors have reported on research that examines the extent to which OxyContin is abused or associated with criminal activity (1,3-5). One recent article (6) examined the effects of newspaper representations of drugs such as OxyContin on opioid-related mortal- ity and abuse, arguing through a quantitative analysis that media coverage publicizing their psychoactive effects and abuse may popular- ize and increase their illicit use. Our concern in the present study was not to examine the effects of OxyContin on society or human health, nor to analyze the damage to human health that media representations of the drugs may cause. Instead, our goal was to analyze competing representations of OxyContin as both a deadly street drug and a legit- imate medication for the treatment of pain. In doing so, we contribute to a well- established body of literature on the construction of social problems, drug scares and the media’s involvement in both (7-13). In sociology, the term ‘social problem’ is defined as “an alleged situation that is incompatible with the values of a significant number of people who agree that action is needed to alter the situation” (14). Each part of this definition is important. First, a social problem must be alleged (ie, said to exist, talked about); for a phenomenon to be defined as a social problem, it must be discussed as such in a social arena. Often, for example, the public arenas of the news media are used to make the case that a phenomenon constitutes a social prob- lem. Second, for this phenomenon to be regarded as a social problem, it must be incompatible with some peoples’ values; a moral judgement must be attached to it. A social problem is something that is defined as somehow wrong, at least by some people (although others may dis- agree). Third, the phenomenon must be identified as a problem by a significant number of people. The actual number is quite arbitrary, but the people themselves may not be because “some people are more sig- nificant than others” (14). Those