So Why Did a Super Bowl Constipation Ad Leave Some Fuming?

If you watched this year’s Super Bowl commercials, the offbeat ad showing a man envying the rest of the world (dogs included) their bowel movements may have registered as nothing worse than a case of TMI. But to those on the front lines of the nation’s battle against opioid addiction, it was maddening. Why? The commercial promoted a new medication that helps ease the extreme constipation that can be a side effect of using opioids (also referred to as opiates), which are a highly addictive class of drugs that includes prescription painkillers such as OxyContin and street drugs like heroin. To many, this was seen as an offensive attempt by pharmaceutical companies to further profit off a deadly addiction epidemic they are charged with helping create and to encourage continued opioid use at a time when we should be doing everything we can to get the lid back on Pandora’s box. The makers of the drug, pharmaceutical companies AstraZeneca and Daiichi-Sankyo, paid a cool $10 million to air the ad in the coveted Super Bowl time slot. The actual name of the drug, Movantik, was never mentioned in the ad, but much was made of finally having a way to deal with what was termed opioid-induced constipation, or OIC. Among those expressing outrage at the ad was Vermont Gov. Peter Shumlin, who tweeted:

In an open letter, he called on the drug makers to pull the ad and suggested if they had $10 million to throw around, that the money could be better spent helping to fund opioid and heroin prevention efforts. He also referenced some of the history of the nation’s progression toward an addiction epidemic that has made drug overdose the leading cause of injury death in the U.S., topping even car crashes.

“Pain management in America is too reliant on FDA-approved opiates. In 2012, enough opiate prescriptions were written to give every American their own bottle of pills. The irrational exuberance with which opiates are handed out in America is driving the addiction crisis in this country. Now is the time to change that, not attempt to further normalize long-term opiate use by advertising a drug to help people take even more opiates.”

Although opioids can be an appropriate way to deal with some pain, a 2015 analysis of opioid research by a National Institutes of Health (NIH) panel concluded that the addiction risk often outweighs the benefits, and people may be missing out on better forms of treatment because the tendency has become to default to opioids. And while opioids are often used to deal with ongoing pain, the NIH analysis concluded: “Evidence is insufficient for every clinical decision that a provider needs to make about the use of opioids for chronic pain.” The popularity of opioids skyrocketed beginning in the 1990s with aggressive and in some cases openly fraudulent pharmaceutical company marketing that downplayed risks. Doctors were encouraged to embrace the idea of stepping up their efforts to soothe patient pain, and patients themselves were happy to leave a doctor’s appointment with a prescription in hand. The result has been a prescription addiction epidemic that has also played a part in a dramatic rise in heroin use. Since 2000, more than half a million people have died from drug overdoses, the majority of those due to opioids, according to the Centers for Disease Control and Prevention. It’s not hard to see, then, why a commercial that seems to suggest all you need is another drug to keep using opioids comfortably would strike a nerve. Some police departments were among those venting their anger about the Super Bowl ad. The Burlington Police Department in Vermont, for example, complained on social media about being left to “clean up the mess” caused by the pharmaceutical companies’ rush for profits, adding:

A Chicago medical program director may have had the simplest solution for the problem AstraZeneca and Daiichi-Sankyo now want to fix with their constipation-reducing drug:

Sources: Reuben DB, Alvanzo AA, Ashikaga T, Bogat GA, Callahan CM, Ruffing V, et al. National Institutes of Health Pathways to Prevention Workshop: The Role of Opioids in the Treatment of Chronic Pain. Ann Intern Med. 2015;162:295-300. doi:10.7326/M14-2775 “In Guilty Plea, OxyContin Maker to Pay $600 Million” “Drug Overdose Deaths Hit Record Numbers in 2014”

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