Veteran journalists and expert share ideas on how to better cover the opioid crisis

As the United States faces a worsening opioid drug crisis, health experts offered an overview of the epidemic, explored the rise in toxic drug combinations, and suggested new ways of approaching the story in a webinar hosted by the Center for Health Journalism this week.

“We are in the midst of a severe epidemic that’s fueling record high levels of opioid overdose deaths,” said Dr. Andrew Kolodny, the co-director of Opioid Policy Research at the Heller School for Social Policy and Management at Brandeis University.

Kolodny, also the executive director of Physicians for Responsible Opioid Prescribing, said the crisis is a story of addiction and over-prescribing rather than simple drug abuse. Journalists Lisa Girion, top news editor of the Americas for Reuters, and Kimberly Kindy, a national investigative reporter at The Washington Post, also dispelled common misconceptions about the people most affected by the epidemic and shared reporting tips from the epidemic’s frontlines.

Misinterpreting data

Since 2011, the number of prescription opioid deaths has plateaued while deaths involving heroin have sharply risen, Kolodny said.

“What you’re hearing is that the pain killer problem has turned into a heroin problem,” he said. “That makes for a good story — the government tries to tackle one problem and inadvertently creates a new problem — but that isn’t really what’s going on.”

People are not suddenly switching from painkillers to heroin, he said. Instead, two different groups are addicted: younger Americans are using heroin and older Americans are using prescription drugs. He attributed the steep rise in heroin deaths in 2011 to synthetic opioids such as fentanyl, which dramatically increases the potency and toxicity of heroin.

The country is dealing with an addiction epidemic, not an abuse epidemic, Kolodny said, the result of the medical community over-prescribing opioids. He also blamed opioid manufacturers that encouraged providers to treat pain with the prescription painkillers. And, Kolodny also pointed a finger at state medical boards for their failure to discipline doctors, even when a complaint is registered against a provider for over-prescribing.

Addressing the opioid epidemic should mirror efforts to combat diseases such as HIV or Ebola, Kolodny said. First, new cases need to be prevented. Second, people who have the disease need to receive treatment.  

Those goals can be achieved, in part, through “much more cautious” prescribing of pain killers, cracking down on “pill mills,” and improved access to treatments such as buprenorphine, a medication which has been shown to reduce opioid overdose deaths.

The media plays a critical role by providing an accurate portrayal of the epidemic and its root causes, Kolodny said: “The problem is not abuse — both pain patients and recreational users are becoming addicted.”

Dispelling the conventional wisdom

In her reporting for the Los Angeles Times, investigative journalist Lisa Girion also took a critical look at another commonly-held belief about the opioid crisis: that it was being fueled by “bad people,” or teenagers popping pills for recreational use.  

Carefully examining data on death tolls gave Girion and her team pause. The death toll was highest for people in their 40s, which struck them as odd. Those who were dying were not the ones typically seen as driving the problem, she said.

Reporters gathered records on thousands of overdose deaths in Southern California over six years. In nearly half of the cases, one or more drugs prescribed for the deceased contributed to the death.

That was a “a game changer” in their reporting, Girion said.

Her team took a closer look at 298 patients under the care of 71 doctors with three or more patients dying of overdose from prescriptions they wrote. The average age was 48. 

“They weren’t people who were stealing from grandma’s medicine cabinet or having pill parties on weekends,” she said.

Instead, they were people who had experienced injuries on the job or car accidents, and got involved with doctors to help with pain.

The linchpin in the “Dying for Relief” series was coroners’ reports for suspected overdoes. The reports included information such as detailed pill bottles collected at the scene, with the names of prescribers on them.

With those 298 patients, the reporting team dug in and evaluated whether these patients should have been prescribed an opioid in the first place. Reporters looked for red flags for addiction in these patients’ medical histories, such as attending rehab, suicide attempts or mental illness. All but five patients had at least one such red flag.

Subsequent reporting delved into the role of drug maker Purdue Pharma and what the company knew about high prescribers and suspicious pharmacies.  

Drug combinations take devastating toll on middle-aged white women

Investigative reporter Kimberly Kindy started her opioid investigation for The Washington Post with a guiding question: Why is there a growing rate of premature death among middle-aged white women? 

The answer led her to Bakersfield, California, where she focused her on-the-ground story telling.

Before visiting the area, she “burned the phone lines,” reaching out to church leaders at mega churches, county mental health workers and psychologists. She connected with Ellen Eggert, a supervisor for the Kern County Mental Health Department who ended up being her “door opener.”

Eggert, who lends support to those at risk for suicide and families affected by it, led Kindy to numerous sources, including the women she used as the face of her story. In the piece she reported with data journalist Dan Keating, Kindy told the story of Karen Franklin, a woman who was taking more than a dozen different prescription drugs. Her journey to addiction started with a back injury and unraveled from there. “One thing seemed to lead to another,” Kindy said. 

Kindy interviewed experts who explained how opioids can lead to other drugs such as sleeping pills. She looked into the potentially devastating impact these drugs in combination can have on one’s body. When she needed a burdensome number of public records from the coroners, her “door opener” Eggert helped her yet again.

Kindy said she’d like to see more reporters examine the problematic combination of anti-anxiety drugs known as benzodiazepines and opioids: “There’s a whole huge area of coverage and policy questions that could receive more attention.”

Addressing the epidemic requires local, community-oriented support systems for people who are using pain killers to numb the pain of their lives, she said, arguing against a top-down national solution.

“It’s a local issue and that means communities need to mobilize and find ways to address these problems,” she said. 

When you look at the counties across the country that are hit the hardest by this crisis, their demographics vary greatly, Kolodny said. They do share one thing, though, in common: “It’s where (opioids) are prescribed aggressively … They are overprescribed by the medical community.”

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Watch the full webinar presentation here: