The initial search yielded 817 news articles. A more comprehensive review identified 554 relevant opioid and opioid crisis stories. Initial reporting began in 2001; the early years had none to very few opioid-related articles (Fig. 1). The predominant article type was news reports (73%, n = 405), although opinion-editorial articles as well as human interest stories were popular as well (Table 1). News reports and editorials were typically centered around statements of risk or criminal activity, while the anecdotes and opinion-based stories tended to focus on the far-reaching implications of opioid addiction from either the patient or provider perspective.
Table 1
Characteristics of Articles
Location of article | # of articles (% of total*) | Article Type | # of articles (% of total) |
Banner Headline | 68 (12.4%) | News report | 405 (73.1%) |
Front page other section | 116 (21.1%) | Human interest stories | 38 (6.9%) |
Front section (but NOT front page) | 273 (49.6%) | Opinion/editorial | 108 (19.5%) |
Not front page or front section | 91 (16.6%) | Other (statistics, exposés etc.) | 3 (0.5%) |
*Note that some articles did not have a location/page listed |
The number of opioid related articles peaked in 2009, again in 2012, and substantially increased in 2016. Manual review of the opioid-related stories revealed that peaks in news coverage often coincided with major developments in or reports on the epidemic (Fig. 1).
Language and Types of evidence
Of all 554 articles, 24.9% (n = 138) referred to general statement of risks as evidence to support its claims. Only 13.4% (n = 74) of articles referred to some form of scientific study as evidence. From 2009–2018, the use of stigmatizing language such as “junkies” and “abuser” in reviewed newspaper articles saw decline, as did the term “drug addict” (Fig. 2). In 2012 we noted the emergence of the term's “user” and “drug user”, and more recently, the use of less stigmatizing terminology such as “people who use drugs” or “people who suffer with addiction”.
A common framing characteristic of media reporting of opioid use and addiction is the use of hyperbole that dramatize or sensationalize the issue (Morris, 2004). Examples include newspaper headlines such as “Drugs ravage picture-perfect community” (Moore, 2011) and “We have opened Pandora's box - it's going to haunt us” (Weeks, 2014). Descriptions such as “teenage girls would do housework in their underwear in return for pills”, “abusers cut up the patches [fentanyl patches] and eat the pieces”(Editorial, 2015) and “thefts and break-and-enters so they [people who use drugs] can feed their habits”(Radwanski, 2010), also demonstrate how the issue was being framed.
Emergent Themes From Social Representations And Blame Patterns
Content analysis of the articles resulted in themes associated with key groups such as physicians, pharmaceutical companies and foreign countries, amongst others.
Some of the most common social representations among the articles was the attribution of blame to pharmaceutical companies, physicians, and foreign countries. The role of the pharmaceutical industry in motivating the massive rise in opioid prescriptions (Goldman, 2012; Howlett, 2017b), and how, if at all, they were being held responsible for their actions in Canada and abroad were widely discussed. Representations of pharmaceutical companies emphasized “profit over patients” and can be easily anchored to the public’s predisposed lack of trust towards the global pharmaceutical industry, also known as Big Pharma (Olsen & Whalen, 2009).
As stewards of the legal opioid supply, physicians’ role in the creation of the opioid crisis, either by overprescribing, indiscriminately prescribing, lack of proper training and education on pain management leading to liberal prescribing etc., was also called in to question. Accordingly, articles discussed out-dated provincial opioid prescribing guidelines (Paperny, 2009a; Sud, 2016), and the creation of national opioid prescribing guidelines to improve and standardize prescribing practice (Paperny, 2012a; Weeks, 2010, 2015). The media’s representation of physicians often included reference to influence from the pharmaceutical industry – “doctors began prescribing opioids two decades ago to relieve moderate to-severe pain as pharmaceutical firms promoted their benefits” (Howlett, 2017a). Thirty-eight percent (n = 86/227) of all articles designating blame, discussed misconduct on the part of pharmaceutical companies and/or physicians.
Within the overall discourse surrounding the illicit drug supply, blame on one collective, a foreign country, also emerged. The smuggling of contaminated drugs, often laced with Fentanyl, from China into Canada was widely reported: “…it's easy to buy the stuff [Fentanyl] from black-market labs in China, with massive quantities of drugs of unknown provenance and quality shipped here under the noses of police and the Canada Border Services Agency” (“Canada, world leader in opiate addiction,” 2016). Of the articles designating blame, nearly half (42.7%, n = 97) blamed the tainted and/or illicit drug supply for rise in opioid related deaths (Karstens-Smith, 2018). An investigation into the source of illicit fentanyl, conducted by the Globe and Mail in 2016 (Howlett, Karen, Giovannetti, Justin, VanderKlippe, Nathan, 2016) stated was often referenced to confirm this. Many articles thereafter detailed the drug trafficking (Bains, 2017; Howlett & Woo, 2016), and joint efforts between China and Canada to curb such activities (Dhillon & Howlett, 2016). The social representation of China and their role in the opioid crisis can be anchored to the public’s potential distrust towards Chinese government activities following several food and drug safety issues over the years (Hedlund, Coyne, Sanford, & Huddelson, 2013; Meixler, 2018; Qiao, Guo, & Klein, 2010).
It is important to note that these media representations of blame evolved as the long-term consequences of opioid overprescribing became more apparent. Understanding both, we saw that many early articles (2000–2006) focused on the need for opioids for pain management and discussed opioids’ apparent addictiveness (Caldwell, 2001; McIlroy, 2006). Following this (2007–2012), the vast majority of articles addressed the steadily increasing rates of prescription painkiller use and fatal and non-fatal opioid overdoses (Agrell, 2007; Paperny, 2009b). During this time, gaps in the healthcare system (lack of chronic pain management, access to counselling, harm reduction services etc.) and overprescribing (or referred to as liberal prescribing) by physicians with influence from the pharmaceutical industry were blamed (See Fig. 3) (Goldman, 2012; Weeks, 2011). Policy-related articles also developed along with this recognition, initially focusing on the need for opioid prescribing guidelines for healthcare providers, pharmaceutical tracking systems (Karen Howlett & Church, 2015). From 2012 onwards, the growing prevalence of substance misuse was thrust into the spotlight with several high-profile overdoses (Dhillon, 2013; Dowbiggin, 2012) and the delisting of high-dose prescription opioids from province's drug plans (Paperny, 2012b; Weeks, 2012). It was also at this time that blame patterns shifted away from physicians and the pharmaceutical industry, towards a tainted and increasingly potent illicit opioids supply (Bains, 2017; Posadzki, 2014). Next, between 2014 and mid-2016, opioid related overdoses continued to rapidly increase, and policies focused on better overdose surveillance and expanded access to Naloxone, a drug that can reverse opioid overdose. Throughout the last few years (mid-2016 to 2018), policies focused on approving and opening additional supervised consumption sites (Bailey, 2016; The Canadian Press, 2017; Woo, 2017); the blame still very much placed on the illicit drug supply of opioids such as fentanyl from China (Dhillon & Howlett, 2016; Fife & Steven Chase, 2017).