A man named Devin, who has been in recovery from opioid addiction for more than a decade, shares what it was like to struggle with his disease. "I was stealing from people, buying substances on the street, and I look back at that time with a lot of shame, you know, that’s not who I am ... Opioid use disorder is not a moral failing," he says in a government-funded ad campaign intended to curb opioid abuse.
Devin now has a family, a master's degree, and a career, and his story is part of an awareness campaign that aims to educate the public about the dangers of opioid abuse. Devin's addiction began with a 30-day prescription from a doctor around the age of 16, following a procedure to remove his wisdom teeth.
The ad, among others, is part of an "Rx Awareness" pilot program that has been running since September in parts of Kentucky, Ohio, Massachusetts, and New Mexico that have high rates of addiction. The program, by the Centers for Disease Control and Prevention, is set to run for 14 weeks as health officials evaluate if the ads are reaching the right audiences and how to boost messaging on those that are working.
President Trump recently joined the effort by donating his third-quarter salary of $100,000 to build off the ad campaign. Creating an "aggressive media campaign" on the dangers of drugs and framing it as a disease rather than a moral failing is one of 56 recommendations laid out by the opioid commission he created, which is led by outgoing New Jersey Gov. Chris Christie.
The larger ad campaign to come will be "massive," Trump vowed as he delivered a speech in October directing his administration to declare the crisis a public health emergency.
The administration has not said how much it will spend on the larger campaign. The Trump administration has said Congress must appropriate funds for the opioid crisis but hasn't put out a specific request or detailed which recommendations from the commission it plans to follow.
The pilot ads that have aired are different from the anti-drug messaging delivered to young people during the 1980s and 1990s. In those ads, teens were instructed to "just say no" to drugs and shown videos of an egg frying in a pan as a voice-over said, "This is your brain on drugs." Studies have shown that the ads were not effective in changing behavior.
The message has evolved for approaching the opioid crisis, partly because many opioid addictions begin with a prescription from a doctor for painkillers such as oxycodone or hydrocodone. After patients become hooked, they turn to the drug's cheaper street counterpart, heroin, which has increasingly been laced with fentanyl, a more potent opioid. As a result, more than 33,000 people in 2015 died from opioid-related overdoses, according to latest available data from the CDC.
A Department of Health and Human Services official said other messages will remind people who take prescription painkillers to use them appropriately and will contain information about helping friends and families support people close to them who have addictions or have overdosed.
The other pilot program ads detail how a person's addiction began with a prescription, how quickly they succumbed to addiction, and the losses that followed: a job, a home, or the death of a family member. Each video is accompanied with the message: "Prescription opioids can be addictive and dangerous. It only takes a little to lose a lot," and then directs viewers to the CDC's online campaign.
Evidence about the effectiveness of public health campaigns is mixed. The opioid commission acknowledged that in its report, saying that even though awareness can be increased through ads, they aren't always successful in changing behavior. Including information about where to receive treatment would be key, the commission concluded.
A 2010 study in the Lancet, a medical journal, found that results varied according to the behavior being targeted and what kind of message was promoted. For instance, it found strong evidence that ads targeted at smoking changed behaviors, but that ads about alcohol showed little evidence of any benefit and ads on nutrition were more effective when they promoted healthy foods.
The Obama administration credited a $54 million anti-smoking campaign called "Tips from Former Smokers" with helping 100,000 people quit. The ads featured smokers discussing some of the side effects they faced, such as losing their voice boxes to cancer, having a high-risk pregnancy or losing teeth. HHS Acting Secretary Eric Hargan recently touted the CDC's anti-smoking campaigns in a recent visit to the agency.
Advocates tend to agree that a mass media campaign, when done with accurate and helpful information, can be an effective part of prevention.
"We know ad campaigns work. That's why the private sector uses them all the time," said Dr. Georges Benjamin, executive director of the American Public Health Association.
He adds that such advertising campaigns tend to be expensive. In 1998, the annual funding request for an anti-drug media campaign aimed at youths was $200 million a year, a sum that was doubled because it was matched by outside entities.
The money for such campaigns involves conducting studies on an audience, laying out which behaviors the agency is trying to change, doing trial runs and then tracking how effective the ads are, Benjamin said.
He stresses that the ad campaigns should be part of a broader strategy that involves access to treatment, regulatory changes, and tackling the black market. He acknowledged that several strategies have been implemented by different health agencies under the Trump administration, but said it would help to have a blueprint to know how the ad campaign would fit into a broader plan.
Dr. Corey Waller, chairman of the legislative advocacy committee for the American Society of Addiction Medicine, agreed.
"There are 'things' going on," he said, specifically using quotation marks. "The problem is I’m not able to see a coordinated, concerted effort to build the addiction ecosystem that we need."
Trump's comments on the topic have been mixed. Solving the crisis would "require us to address the crisis in all of its very real complexity," the president said in his Oct. 26 speech declaring the opioid crisis a public health emergency. He also, however, stressed the need to have children avoid using drugs in the first place. He drew on his own experience avoiding tobacco and alcohol because his brother Fred died from alcoholism.
"The fact is, if we can teach young people, and people generally, not to start, it's really, really easy not to take them," Trump said.
That portion of the speech drew criticism from those who likened it to the "just say no" anti-drug campaigns during the 1980s, such as the Drug Policy Alliance, which opposes the way the U.S. has pursued anti-drug policies that have stressed criminalization and resulted in massive incarceration.
The opioid commission pushed back on such characterizations.
“The commission, through its report, made clear that opioid addiction is a complex issue with many factors, including the fact that many people start with an opioid prescription for legitimate medical use," said Brian Murray, press secretary for Christie. "The recommendations speak for themselves in regards to messages that can be delivered to the public. If anyone thought that saying 'just say no' were the solution, there would not have been a commission formed or a resulting 100-plus page report delivered with specific suggestions on combatting this crisis.”
The commission recommended a similar campaign to the one issued during the AIDS epidemic, which sent a mass mailer to U.S. households to educate the public about how the virus was spread. It also cited a Food and Drug Administration anti-smoking campaign called "The Real Cost" as an example to emulate.
Waller said that if the administration "puts all its eggs in one basket," it could go a long way toward reducing stigma about addiction.
"The biggest area is in decreasing stigma ... that this is a chronic brain disorder and not bad decision-making," he said. "I think we have to continue that."
• Correction: The duration of the opioid campaign has been corrected. It will run 14 weeks.