Skip to Main Content

Abuse of prescription painkillers has grabbed center stage in conversations about the nation’s opioid epidemic. Presidential candidates talk openly about their relatives’ struggles with addiction. Officials at the state and federal levels ponder ways to restrict the number and dosage of pills doctors can prescribe.

That’s why it was so striking to see a Super Bowl ad that took a different tack: It aimed to stir empathy for patients who truly need the drugs to manage chronic pain.


The 1-minute spot targeted viewers who “need an opioid to manage chronic pain” — and who suffer from a common side effect of the pain relievers, constipation.

Striking a balance between humor and gravitas, the ad featured a man suffering from the condition who can’t help noticing that everyone else around him can poop: A dog on the street. A woman with toilet paper stuck to her shoe. Even a sugar shaker dispenses crystals with ease.

The ad drew sharp rebuke from high-profile observers on social media, who saw it as a tone-deaf commercial play amid a devastating public health crisis.


“Big pharma buys #Superbowl ad to warn about the most pressing effect of opiates: constipation. Thanks. For nothing,” tweeted the police department in Burlington, Vt.

Even White House Chief of Staff Denis McDonough weighed in on Twitter: “Next year, how about fewer ads that fuel opioid addiction and more on access to treatment.”

But several advocates for patients with pain saw it differently. They spent months advising drug makers on the ad, and said their goal was simple: to illuminate one of the burdens faced by the patients they represent.

Paul Gileno, president of the US Pain Foundation, was particularly troubled by a coarse tweet from comedian Bill Maher, who joked that the ad seemed to be aimed at “junkies.”

That happens all too often, Gileno said: Patients in persistent, terrible pain are wrongly “labeled as junkies or pill seekers” because they seek relief. Yes, he said, there’s a need to educate people about painkiller abuse. But there’s also a need to remind the public that these drugs have legitimate uses.

“There is a huge need for education on both issues,” Gileno said.

“We definitely see both sides of the issue, and both sides need to be dealt with, but we can’t forsake one of the issues,” said Barby Ingle, president of the International Pain Foundation.

The ad didn’t promote a specific medication. Instead, it urged patients to ask their doctor about prescription treatment options for the condition. It also plugged a website that links to information about Movantik, a drug marketed by the ad’s makers, AstraZeneca and Daiichi Sankyo.

The spot was directed by Lenny Dorfman, a veteran ad maker with Hungry Man Productions who works on commercials for big-name consumer brands like Nike and Coca-Cola.

Super Bowl ads tend to focus on products and issues that have mass appeal. That’s why, for example, you tend not to see the ads for erectile dysfunction that dominate the airwaves during regular season NFL games.

So it was telling that the advertisers deemed prescription opioid users suffering from a particular side effect to be a large enough market to justify a Super Bowl ad. Thirty-second spots during the game sold for up to $5 million.

Abigail Bozarth, an AstraZeneca spokeswoman, said the company’s goal was to “open the door” for patients with opioid-induced constipation to talk with their doctors, “which provides another important touch point to help ensure opioids are being appropriately used.”

In 2014, prescription opioid pain relievers killed about 19,000 people, up more than threefold since 2001.

This story was updated with more information about the response from local and federal officials to the Super Bowl ad.