‘Trapped in a Bottle’ Billboard Misses the Mark

By Dr. Lynn Webster, PNN Columnist

The mission of The Partnership for a Drug-Free New Jersey (PDFNJ) is to reduce substance use and misuse in New Jersey. The non-profit has received more than 200 advertising and public relations awards for its public service campaigns.

Much of the organization’s work is laudable, but their new "Trapped in a Bottle" campaign spreads misleading and harmful information about opioid medication.

Digital billboards of a man or woman trapped in a prescription bottle appeared in Times Square and on mass transit. The billboards end with a warning: “In just 5 days, opioid dependency can begin.”

Physical Dependence vs. Addiction

The ad talks about dependency, but it conflates dependency with addiction.

Physical dependence is a process that starts with exposure to the first pill. Discontinuance of an opioid may lead to withdrawal — but the hyperbolic ad can easily be mistaken to be about addiction rather than dependency.

Dependency is a normal neuroadaptation that takes place when certain brain receptors are exposed to drugs, including opioids. These drugs change the structure and function of a receptor with continual exposure, and that can result in physical dependence. If the drugs are abruptly stopped, that can cause withdrawal.

Using opioid medication for as little as five days will almost never induce withdrawal. And even if withdrawal occurs after taking a short course of opioids, it does not mean the person is addicted or has an opioid-use disorder.

The "5 days" concept is meaningless because it spreads unhelpful myths about opioids. I have prescribed opioids to thousands of patients and have never seen a patient experience withdrawal when stopping within a week or even two. Managed properly, the overwhelming majority of patients experience no negative effects from dependency.

Addiction, on the other hand, requires much more than simply ingesting a pill, and it does not occur in any specific number of days. The development of this disease is a process that involves multiple factors and occurs over time.

It is important to remember that addiction is not resident in the drug, but rather in human biology. Exposure to an opioid is a necessary, but by itself is insufficient to cause the disease.

For people who develop an addiction, opioids provide a reward, and the brain seeks to repeat the pleasurable experience. For a vulnerable person, one pill can be so rewarding that it drives pleasure-seeking behavior that can lead to addiction. But that does not happen in five days or on any other timetable.

This is not the first time PDFNJ has created over-the-top digital billboards to scare people away from using prescription opioids.

A 2016 billboard intended to frighten parents asked: "Would you give your child HEROIN to remove a wisdom tooth?"

This melodramatic question was followed with: “Ask your dentist how prescription drugs can lead to heroin abuse." The innuendo is neither educational nor informative.

It's understandable that an advertising agency would have trouble accurately conveying the problems of drug dependence and addiction when the news media also has difficulty communicating the facts.

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Inaccurate Portrayal of the Opioid Crisis

In a recent WPIX article describing the “Trapped in a Bottle” campaign, Mary Murphy wrote that “drug overdoses killed more than 72,000 people in the United States in 2017, a new record driven by the deadly opioid crisis.”

Murphy used the statistic to help illustrate the harm of prescription opioids. But prescription opioids were involved in less than 20,000 of those drug deaths. If Murphy wanted to use a large number, she should have said there were 150,000 deaths from substance abuse in 2018. This would include alcohol-related deaths. Of course, alcohol delivers its poison in a bottle, too.

Murphy writes that a large percentage of drug overdoses can be attributed to heroin or fentanyl. Indeed, these are major sources of opioid deaths, but she fails to point out that neither heroin or illicit fentanyl are prescription opioids. Nor are they commonly found in a bottle. Again, her implication is that prescription opioids are at the heart of this crisis.

Concepts Video Productions, which is based in Towaco, New Jersey, produced the digital billboard. “Each year, we select a pro-bono project that will impact the world,” said Collette Liantonio, creative director of the production company.

The “Trapped in a Bottle” billboard, however, may do nothing for the world besides demonstrate how imperfectly most people understand the reason for the drug crisis and reinforce prevalent myths about it.

Perhaps Concepts Video Productions should consider creating a billboard that shows someone who is unable to find a job that pays a decent wage, and seeks to escape poverty and hopelessness with drugs. Economic and social woes, rather than prescription drugs, are at the core of our country's drug crisis.

Or perhaps Concepts Video Productions should create a giant digital billboard full of people with chronic pain who can’t get out of bed because their doctors refuse to prescribe the medication they need.

Using fear to solve the drug crisis will never be successful.

Moreover, knowing a drug's potential to lead to physical dependence or addiction will not prevent anyone from seeking a psychological experience to escape painful life experiences. The answer is to address the emotional and physical needs that create dependency or addiction in the first place.

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Lynn R. Webster, MD, is a vice president of scientific affairs for PRA Health Sciences and consults with the pharmaceutical industry. Lynn is a former president of the American Academy of Pain Medicine, author of the award-winning book “The Painful Truth” and co-producer of the documentary “It Hurts Until You Die.”

You can find him on Twitter: @LynnRWebsterMD.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

My Opioid Dependency Turned into Addiction

By Jim Best, Guest Columnist

When I was in my early 40’s, I had an accident at work that injured the discs in my lower back. I tried physical therapy, but after three months of little improvement they performed a discectomy.

The surgery was successful and I had very little pain until a year later, when I re-injured the same area. I was taken to the hospital in an ambulance and a neurosurgeon decided I needed emergency surgery and performed a laminectomy. This time, the pain came back after less than six months. I was in constant pain (most days rated somewhere between a 6-8) and unable to work. 

The next ten years included numerous trips to various providers, including pain specialists. I was evaluated by orthopedists and neurologists, and informed I was not a good candidate for spinal fusion surgery due to my overall body structure. They took more than a dozen MRI’s and I was subject to painful spinal injections on a regular basis.

I was also given a discogram, which is an extremely painful diagnostic procedure involving the insertion of needles into the spinal discs. The pain was so severe from this procedure that I passed out. The results were “inconclusive.”

During those ten years I was also introduced to opiate medication. They started me off on Vicodin and I was eventually prescribed OxyContin by my regular doctor. I took relatively small doses to start, but it didn’t take too long before I was being prescribed larger and larger doses.

What I didn’t know was that the more I took, the more I thought I needed. This is known as opioid-induced hyperalgesia, a syndrome in which people can become hypersensitive to painful stimuli due to prolonged use of opioids.

Although at the time I was sure that had nothing to do with my case, now I see where it made perfect sense and I should have ceased my opiate use immediately. However, I continued to use for five additional years. 

JIM BEST

JIM BEST

An important part of my story concerns my addiction to alcohol, which I stopped using in 2005. I was a stalwart member of AA up until 2015, when I had a relapse. I never really discussed my use of painkillers with other people because I was afraid they would think I might have a problem with pills. Of course, they would have been correct, but I fooled myself into thinking I was okay.

That is part of the self-delusion of any kind of drug use, but perhaps more so with opiates because they were prescribed by a doctor and because I felt I had a legitimate reason for using them -- a rationalization I maintained even when I was using far more than prescribed.

Looking back, I do not believe I should have ever been prescribed opioid medication due to my addictive personality. I don’t blame the doctor who prescribed them to me. I would tell her horrible stories of not being able to get out of bed without the pills, or how some days all I could do was sit in a chair and cry. I believe that as a physician (as well as a caring and compassionate human being), she was concerned with my pain and truly thought she was doing what was in my best interest.   

It’s important to make one fact clear: I was in pain. Although I certainly hyperbolized my symptoms to my doctor, girlfriend and a few others, I did have daily chronic pain. And I was dependent on the drugs to provide some modicum of relief.

There came a time, however, when the dependency turned into an addiction. I literally could not function without large doses of the drugs. I also began to abuse them by taking more than prescribed and taking them in non-prescribed methods such as snorting.

The end of my use came when I got busted by my doctor. She caught me in one of the myriad of lies I had to tell because I would run out of pills before the next prescription was due. She gave me a script for 10 Xanax and basically told me good luck.

I went through withdrawal for a few days and then, after almost ten years of sobriety, I started to drink again. Eventually, I ended up in treatment. I admitted to the counselors at the treatment center that opioids were also “sort of a problem.” Luckily, they saw through the lie and I was put on Suboxone. I still take the Subs because they help with the pain and I don’t have the urge to use anymore.

I still experience daily pain. Some days it is bad enough that I have to be very careful with how much I exert myself. But I manage to get by without the pills.

As an aside, I feel like the current restrictions being put on opioid medications are too extreme. Not everyone that takes them has a problem and by restricting them, as many states currently are, they are making life very difficult for the ones using them responsibly.

What other people do is their business. For myself, taking such medications is no longer an option. I hope this story helps someone. 

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Jim Best lives in Minnesota.

Pain News Network invites other readers to share their stories with us. Send them to editor@painnewsnetwork.org.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.