WASHINGTON — One commercial ends with a young woman unbuckling her seat belt, flooring her gas pedal, and ramming her car into a dumpster. Another shows a young man opening his garage door, sifting through a toolbox, and forcefully slamming a hammer down on his left hand.

Both are part of a new White House campaign aimed at educating adults ages 18 to 24 about the perils of opioid misuse and illustrating the lengths to which some go to obtain prescriptions for the highly addictive painkillers. The effort, White House adviser Kellyanne Conway told reporters on Thursday, will use four “hyper-realistic” narratives based on real events from young adults around the country.

While the circumstances in each ad vary, all four aim for a visceral reaction — to scare viewers away from opioid use given the associated dangers.

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That is an approach that has been tried previously in public health awareness campaigns, including the infamous “This Is Your Brain on Drugs” ad campaign from the 1980s. Numerous studies have found that ad campaigns that aim to produce an emotional reaction, instead of producing a change in behavior, often fail to achieve their desired effect.

Still, contacted by STAT on Thursday, two former “drug czars” — one from a Democratic administration and another from a Republican administration —  were largely supportive of the new ad campaign.

“I actually think scare tactics — that are relevant to the target you’re going after — do work,” said Gen. Barry McCaffrey, a former four-star general who ran the Office of National Drug Control Policy under President Bill Clinton.

McCaffrey, who expressed broader frustration with how the Trump administration has responded to the opioid crisis, said he was heartened by the announcement of the marketing campaign.

“I think the ads are powerful, there’s no question in my mind they’ll help,” said John Walters, who served as drug czar to President George W. Bush. “There’s a lot of cynicism about ‘Just Say No.’ The basic principle here is to give people the information and to give them the support to not start self-destructive behavior. That’s what a free people wants.”

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A White House commission empaneled last year by President Trump included a sweeping media campaign in its recommendations, a suggestion the president revisited when he announced his administration would declare the crisis a national public health emergency in October.

Conway said on Thursday that the ads being unveiled were one of many outreach steps to come.

Rafael Lemaitre, who worked at ONDCP during the Clinton, W. Bush, and Obama administrations, said that public awareness campaigns were generally a force for good, regardless of how effective the ads themselves are.  

“I’m not advocating for a ‘Just Say No’-style campaign,” he said. “But what you saw during the mid-’80s was everyone in government standing up and saying: There’s a big problem and we need to do something about it, and the issue was elevated.”

Drug policy experts applauded the collaboration with two nonprofit organizations on message-testing, and said the organizations tested roughly 150 messages before settling on a theme for the ads.

One of the organizations is the Truth Initiative, which has long engaged in similar outreach efforts regarding tobacco use. The other, the Ad Council, partners with advertising agencies to fund public service announcements, and worked with former First Lady Nancy Reagan on the “Just Say No” campaign.

The campaign will largely rely on donated airtime and media resources, said Jim Carroll, the White House’s nominee to lead the Office of National Drug Control Policy.

Representatives for the Ad Council and Truth Initiative said campaigns like the one rolled out Thursday were typically worth roughly $30 million in ad buys.

The 18-24 demographic, however, is not among those most impacted by opioid addiction and overdose deaths. The White House said the campaign was a preventative tool aimed at breaking a cycle of prescription painkillers serving as a gateway to heroin and illicit fentanyl.

Roughly 60,000 Americans died from drug overdoses in 2016, and 42,000 of those deaths involved opioids.

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  • Such B/S that you have to leave an Email addy just to comment and like one add saying opiates make people dependent in 5 days such a lie especially when you are dependent and have no other option told bye surgeons this is the only help you live with them over 20 years and are depending on them to make it through life shame on you…Huge different and you flash your adds so fact no one can read the website but that’s the US for you. the president saying that media is a shamble then pays for adds like this?

  • The danger of the message, and it is prominent amongst people with SUD is the concept of placing blame on their addiction. “I got hurt, my doctor prescribed and I got addicted!” Takes the focus off the responsibility to recover, complete abstinence is the safest route for those with SUD (not discussing MAT) for long term fulfillment in life. The danger with the narrative is the focus on Opioids minimizes other drug use in the lives of these young men and women. I believe the majority of young people addicted to Opioids would have manifested later in life with alcohol or other substances…

    • Bravo Dan. A true addict will find something else to abuse; they’re chasing a high, and focusing on what they’re using to get high as opposed to the disease itself creates more stigma (thereby making it harder to treat). The life of someone with a true addiction disorder goes downhill when they have access to substances they can abuse to achieve that high; you take one away, and they will most likely find something else to give them that high (and there are many substances left for them to choose from). This is why treating the disease itself works, whereas just taking away their substance of choice often results in the addict finding something else to abuse.

      If one looks at the pain patient group, the more tools we have available to treat their diseases/disorders results in the patient having a better QOL. They can do more when treated properly with the correct medications, and generally have a much lower incidence of abuse.

      Why then is it so hard for the officials making rules and regulations to realize that limiting access to opiate medications is NOT going to have any impact on addiction? The addict will chase the high and find something else to abuse – the pain patient isn’t chasing a high, but as you pull these medications out of their toolbox, they are often left simply with inadequate pain control, loss of functionality and QOL, and in the end will often turn to suicide to end the ravaging pain that consumes their bodies.

      Right now we have an IV drug problem in the US. Pain patients, for the most part, aren’t treating themselves with heroin and illicit fentanyl analogs. The difference between addiction and physical dependence has gotten lost in the noise, and until we change our approach, it’s the pain patients who end up with the short end of the stick. Living the rest of their lives in agonizing pain is not a viable option, and we don’t have other tried and true modalities that treat certain types of pain except for opiate medications. Taking those away leaves the pain patient with nothing except misery, and the only escape is death.

  • Sadly I have heard of this or similar behavior in some of the clientele I serve. I am not entirely convinced that it will serve as a deterrent. Considering that most of them have seen the ravages of addiction in person prior to starting their own use. None of which seems to have been a deterrent.

  • Agree strongly with the physician comments below. We need safe, effective pain management for acute & chronic pain. Buprenorphine has been here nearly 20 years. No OD’s on it used alone without other sedating meds or CNS depression. Read PAIN AND ADDICTION edited by ASAM. It is approved by FDA. Many insurances refuse to cover it for pain, including state medicaid in most states. (Wash. an exception, thx). They all prefer we use cheaper opiates. Hmmm, in the middle of an opiate epidemic? In a few more years, we will be using it as the go to pain med. Ask your doctor for it. Any provider can prescribe it for pain.

  • Go figure, we have research showing “just say no” and scare tactic techniques don’t work and a general saying “I think they do.” Every day the addict faces scare tactics and “just say no” and simply can’t, it’s not the way that disease works. Addiction is a disease of the decision-making part of the brain and until we treat mental illness like physical illness in this country, the problem will worsen. Meanwhile legislation is creeping in that prevents me appropriately treating pain and suffering in my patients.

  • Dear Dr. Lawhern, after reading an article related to the opiate crisis and Whitehouse efforts to create public awareness through add campaigns is a great start but the 18-24-year-old demographic is too late. I treat patients daily for addiction, most started between the ages of 12 and 16 years of age. With the youngest being treated 8 years of age. The problem is far worse than most realize. And I have seen many patients with objective addictive traits after 1 trial of a potent narcotic. So to say somebody cannot get “hooked” after trying 10 pills is not true, they can. What needs to happen is the realization that “not my child” needs to be to the forefront and people need to stop saving face versus saving lives. Many times I treat juveniles that are only pulled by their family for fear of stigma, and what they might lose. Without giving thought to life and or further hastening the addiction dilemma. Additionally, there are many other facets that can be covered better than have been addressed here. I gladly invite you to Pueblo, Colorado where I treat patients on a daily basis in which we happen to have the fifth highest overdose rate in the United States. – PS I will even pay for airfare and lodging.

    Sincerely,

    Jamie Pollock, MD
    ASAM, ABFM

    • And again I ask, why does the current IV drug problem mean that stable pain patients are being denied pain medication? Does anyone think that will actually help? Anyone?

    • Dr Pollock, I’m uncertain where you’re getting your Colorado overdose death rates, but they don’t reflect published numbers in the CDC Wonder database. In 2016, opioid-related mortality from all sources in Colorado was 18 cases per hundred thousand population. That rate is exceeded by in over half of US States.

      We also know that 2016 OD deaths nationally among minors and young adults are six times higher than the rates in people over 50 — who are prescribed opioids 250% more often. These demographics strongly contradict your over-generalizations.

      Opioid addiction is a tragedy wherever it occurs. But we cannot accept public policy that denies care to 20 million people who suffer in severe pain every day, based on “saving” 2 million people with addiction, among whom perhaps 1-2% are unusually vulnerable to prescription opioids. That is simply insane.

  • Ironically, the opioid cowards will probably send Joe home with a prescription for extra strength Tylenol.

  • I am appalled by the outright lies that I hear being repeated in this campaign of outright mythology and propaganda — some of them told by the Surgeon General of the United States! These incompetents should be listening to Dr Nora Volkow, Director of the National Institute on Drug Abuse:

    ““Unlike tolerance and physical dependence, addiction is not a predictable result of opioid prescribing. Addiction occurs in only a small percentage of persons who are exposed to opioids — even among those with pre-existing vulnerabilities… Older medical texts and several versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) either overemphasized the role of tolerance and physical dependence in the definition of addiction or equated these processes (DSM-III and DSM-IV). However, more recent studies have shown that the molecular mechanisms underlying addiction are distinct from those responsible for tolerance and physical dependence, in that they evolve much more slowly, last much longer, and disrupt multiple brain processes.”[i]

    [i] Nora D Volkow, MD and Thomas A McLellan, Ph.D., “Opioid Abuse in Chronic Pain — Misconceptions and Mitigation Strategies” . NEMJ 2016; 374:1253-1263 March 31, 2016]. http://www.nejm.org/doi/full/10.1056/NEJMra1507771

    The notion that anyone can get “hooked” on a few days prescription of Percocet is just an outright made up fiction! So is the lame-brained idea that our opiod “crisis” was created or is being sustained by doctors making prescriptions to pain patients. A recent analysis published by the Alliance for the Treatment of Intractable Pain was briefed to the HHS Inter Agency Task Force on Best Practices in Pain Management on May 30. That analysis demonstrates that there is no relationship between rates of opioid prescribing by doctors versus rates of overdose deaths. None at all. The contribution of medical opoids is so small that it gets lost in the noise.

    As usual, the US and State governments are chasing the wrong “epidemic”. Our crisis of addiction and death is an epidemic of socio-economic despair, not one of medical exposure to pain relievers.

  • Never mind the empirical evidence, let’s go with what we think should work. Shades of the Montana Meth campaign.

  • This approach seems only to be geared towards preventing new addicts, a small proportion of users.
    What approaches are being tried to get more counseling, housing & job helps & other supports for CURRENT USERS to change their life enviornments??

    • Do we seriously think opioid naive young people would go to these lengths just to try the drugs?

    • Yet chronic and intractable pain patients get their medications taken away to help with what part of this campaign? No wonder the suicide rate has risen 30% over recent years amongst veterans and pain patients.

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