The last decade has seen a steady increase in Canadian media coverage on opioid use. The mounting number of opioid-related deaths — over 9,000 since 2016 alone — has led to the characterization of the issue as a crisis or epidemic.
A 2019 University of Toronto-affiliated study analyzed trends in news reporting related to opioids in Canada from 2000–2017 to understand how the portrayal of the issue has changed in the media over time.
Co-authors Dr. Fiona Webster, a medical sociologist and an associate professor in the Faculty of Health Sciences at Western University; and Dr. Abhimanyu Sud, a physician and an assistant Professor in U of T’s Faculty of Family and Community Medicine, discussed the findings of their research with The Varsity.
“The point is not to demonize or vilify the media, or any particular journal per se, but to look at how the media both creates and reflects back to us what our own social values are, [and] what our own beliefs are,” Webster said.
An evolving narrative
In their analysis of 826 Canadian news articles, the emergence of prominent themes around opioids varied greatly from 2000–2017.
The authors noted a clear departure from discussions dominated by clinical pain care and the promise of opioid treatments in the early 2000s to growing concerns over the highly-addictive nature of the substance and critiques of the pharmaceutical industry at the turn of the decade. Concern over physician prescribing practices and deceit by the pharmaceutical industry were then replaced by an emphasis on the illicit drug market and its adulteration with fentanyl in the latter half of the 2010s.
“We found in our study that pharma’s role in all of this for the most part disappeared from view as the crisis continued,” said Webster. “And we thought that was very interesting, and it is important to tell that story.”
Critical content analysis
To identify the underlying societal values and beliefs that have influenced the definition of the opioid crisis in public discourse, the authors used an approach called ‘critical content analysis.’
This method involves “looking at [opioid coverage] with a view not just to describe what we found, but to think about who benefits from these types of stories, [and] who’s being excluded or marginalized,” explained Webster.
The analysis was in part informed by critical theory and what has been termed the ‘new capitalism,’ especially due to its implications across social life. In the case of opioids, individuals with chronic pain or experience with opioids are often among the most vulnerable members of society, and the consequences of advanced capitalist practices materialize through what Webster describes as “ongoing attacks on social welfare systems.”
“We could see that people were being positioned as criminals… [which feeds] into people’s ideas that we should be reducing social benefits for people, that these types of people are somehow unworthy of our attention and our support as a society.”
This belief is closely tied to that of personal responsibility in health, which has led to the moralization of health issues, such as substance use and dependence. Indeed, a 2017 research study showed that patients with substance use disorder face higher stigma for their condition in society than those with other psychiatric disorders.
“That… neoliberal positioning is related to this idea that people are individually responsible for things like their own health, and that view completely ignores the structural and social inequities that produce health disparities,” said Webster.
Beliefs such as these are especially harmful because they not only reinforce stigma against already-marginalized groups, but also preclude conversations about systemic change.
Defining the scope of the problem
The authors noted frequent use of sensational language to characterize opioid use by Canadian news outlets when tackling the opioid problem.
And yet, defining the scope of the issue itself, along with its origin in particular, was often nebulous. “Is the crisis the drugs? Is the crisis how the drugs are used? [We] need to be specific about the locus of the crisis if we want to actually address it,” said Sud.
The authors also identified repeated efforts to assign blame to particular groups or individuals, such as the government or physicians, as a prominent theme. References to criminality — illegal drug use, drug trafficking, and drug-seeking behaviour — were also found to be a recurrent topic in articles attempting to define the nature of the problem.
Furthermore, their findings showed a tendency for high-risk opioid use to be described as a self-contained phenomenon. This is opposed to academic research, which shows it existing in conjunction with other substance use problems and mental health conditions, as well as socio-structural determinants of health.
When asked about her thoughts on the relative lack of coverage on these underlying factors, Webster cautioned against taking too simplistic of a view, but theorized that “It reflects the values of our society and the fact that we would rather think that these problems are caused by drug cartels and street users.”
Indeed, the opioid crisis does not exist in a vacuum; there are many institutional and systemic forces at play. Webster noted that deep-rooted issues such as racism, classism, and gender bias are all implicated in the rise in overdose-related deaths. However, this nuance is rarely captured in news articles.
A telling example is the relative absence of reporting on the impact of opioids on Indigenous communities in Canada, despite there being extensive evidence of Indigenous people being disproportionately affected. This effect is attributable to a historical social context of intergenerational trauma, colonialism, and racism that has been inflicted onto Indigenous people.
The social construction of the “legitimate” versus “illegitimate” opioid user narrative
The authors sought to draw attention to the ways in which the opioid crisis was being socially constructed, and in particular, the ways in which media reporting distorted reality.
A pervasive narrative theme identified in their analysis was the idea of the legitimate versus illegitimate user. Legitimate users were those who became dependent after being prescribed opioids by a physician.
“They don’t misuse [opioids] or divert them or crush them or sell them, but they use it to treat their pain,” Sud noted of the typical media portrayal. “Most explicitly, they’re no junkie.” They were described as ‘the common person’ — otherwise upstanding citizens who had fallen victim to misfortune. Importantly, legitimate users were those perceived as being worthy of care.
“We call this a critical analysis… because we look at what’s there, but you also look for what’s not there, or… what’s not explicitly constructed versus what’s explicitly constructed,” Sud explained.
“So in constructing this legitimate patient, you construct also the illegitimate patient, the person who’s a junkie, who uses street drugs, who’s not working, who’s not employed, and [who’s] not contributing to larger society,” he continued. “This was one of the most… telling sort of construction, because we see this is in the discourse around solutions and interventions around the opioid crisis, and it creates a lot of problems because it pits people against each other.”
The ‘junkie’ stereotype is neither new nor accurate, and as Webster noted, these individuals are often characterized in “very one-dimensional ways,” which is not only stigmatizing but damaging for families who have lost a loved one to overdose.
And while these categorizations themselves are problematic, Sud explained that they can create even more problems when used as the basis for policy.
This work comes at a critical time, as an unprecedented overdose crisis unfolds in Canada and across North America, and media reporting plays an increasingly influential role in shaping the public’s perception of the issue.
Both Sud and Webster reflected on the need for people to “be careful consumers of media of all forms,” and to think critically about the types of stories being told rather than just accepting them at face value.
Disclosure: Indhu Rammohan is the President of the Canadian Students for Sensible Drug Policy U of T Chapter.