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Fighting addiction with a pill

Rating

1 Star

Fighting addiction with a pill

Our Review Summary

This CBS News segment on the drug Suboxone (sublingual buprenorphine) explores the medication’s use as a way to treat addiction to prescription painkillers. Its key strength is its lucid explanation, using a video, of the physiology of addiction and the drug’s mechanism of action.

But the piece falls far short of health journalism best practices in several significant ways.

  • To illustrate the drug’s effectiveness it draws heavily on a single anecdote, which tells the story of a patient who appears to have an unusually successful outcome.
  • It does not cite published research or interview independent sources to verify the drug’s safety and efficacy. It fails to identify the one physician interviewed as lead investigator in the current clinical trial. 
  • It implies the drug is new and novel, yet it has been approved for use as a drug addiction treatment for five years and is not widely used.
  • It fails to explain that the current clinical trial is exploring whether Suboxone, used with counseling in people who are addicted to prescription painkillers, can help people withdraw from the painkillers in one phase and then taper fairly quickly off Suboxone. 
  • It fails to explain that the vast majority of patients who take Suboxone relapse, and that many of those who can stay off the drug to which they are addicted go onto long-term maintenance therapy with Suboxone.

The story appears to draw heavily on an article appearing in the Fall 2007 issue of NYU Physician, a publication of the New York University School of Medicine and Hospital Centers, employer of study lead investigator Marc N. Gourevitch.

The NYU Physician piece focuses on the story of Brian, the same man who is the focus of the CBS News segment.

The CBS piece appears to adapt language from the magazine article. In one place the article reads:  

The hope is that this will eventually do for drug addiction what SSRI’s like Prozac did for depression: convince both primary-care physicians and the public that addiction is a chronic brain disease, not a character flaw.

The physician-reporter in the CBS piece says:

The hope is that one day Suboxone can do for painkiller addiction what drugs like Prozac did for depression: convince people that it’s more of a brain disease, not so much a character flaw.

 

It is also worth pointing out that Brian, according to the NYU Physician article, has had an outcome more complex than viewers might believe. In the NYU article, Brian is quoted as saying that after his initial treatment with Suboxone, his withdrawl was "the worst three weeks of my life," with "sleepless weeks of nausea, chills, diarrhea, apathy, and intense, uncontrolled cravings for opiates."

The CBS segment about Brian did not include this information. 

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The focus of the segment is, properly, the high costs of addiction to painkillers. Still, it fails to state how much Suboxone costs.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The segment fails to report how effective Suboxone is at treating addiction. No data.  Thus, also no data comparing with alternatives (methadone and/or psychotherapy or abstinence-based treatments).  

The drug labeling states that the drug was shown in two trials to be about 17 and 28 percent effective (compared to 6 percent and 9 percent for placebo).

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The drug has considerable safety issues, yet the story didn’t discuss any of them.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The segment does not present any clinical evidence to describe the medication’s effectiveness.

Does the story commit disease-mongering?

Satisfactory

In the interview with Brian, the segment explores the psychological impact of painkiller addiction. But it does not exaggerate the risks or severity of the condition.

Still, it is worth pointing out that the segment fails to state that many patients taking medicines for pain may be physically dependent on them, but do not "abuse" the medicine to get "high" and on balance benefit from its use.  The news piece concerns only people abusing these painkillers, so it may imply that any use of these medications is problematic. This is not true.

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

There are several important shortcomings here:

  • Marc N. Gourevitch is interviewed about the drug but is not identified as the lead investigator in the current clinical trial.
  • The segment uses only an anecdote about one patient with a favorable outcome to demonstrate the drug’s effectiveness
  • No independent sources were consulted. A clinicial practitioner who prescribes Suboxone (and other drugs) for addiction would have been particularly useful.
  • The segment does not refer to any peer-reviewed literature about the drug’s effectiveness.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The segment refers to methadone early on. But it does not mention counseling as a stand-alone option for addiction to painkillers, or other drug- or non-drug options.

Does the story establish the availability of the treatment/test/product/procedure?

Not Satisfactory

The segment states that Suboxone (sublingual buprenorphine) is available from "any doctor, even a family physician."

It’s a bit more complicated than that. In order to prescribe Suboxone, a physican without specialized training in addiction needs to be certified by submitting an application to the federal government, completing an 8-hour training course and meeting other criteria. 

The segment is unclear about availability in a second case. The segment itself implies (correctly) that the drug is currently available. But then the host says the drug is currently in clinical trials. The physician-reporter’s response does not clarify that these trials are for approval of an additional, specific use of the currently available drug.  

Does the story establish the true novelty of the approach?

Not Satisfactory

The segment in places implies the drug is new and novel (by referring to the current clinical trial, by using the word "new" to describe it, and by emphasizing its hope for revolutionalizing treatment). But it also states that it is currently available. This leaves the viewer uncertain about what’s "new" here.

So what is new? Buprenorphine has been an approved parenteral analgesic for decades. The drug was approved in 2002 as an alternative to methadone–a drug to be taken as a more benign replacement for the more addicting drug being abused, such as heroin. It enables withdrawal from the addicitive drug, which may be followed by other addiction treatments or maintenance therapy. 

The current trial involves only patients who are addicted to painkiller medications like OxyContin. The study is designed to determine whether those taking Suboxone and getting supportive counseling can taper off Suboxone fairly quickly and become entirely drug-free.  

Does the story appear to rely solely or largely on a news release?

Not Satisfactory

The article does not rely on any press release. It does, however, appear to draw heavily on an article appearing in the Fall 2007 issue of NYU Physician, a publication of the New York University School of Medicine and Hospital Centers, employer of study lead investigator Marc N. Gourevitch.

The NYU Physician piece focuses on the story of Brian, the same man who is the focus of the CBS News segment.

The CBS piece appears to adapt language from the magazine article. In one place the article reads:  

The hope is that this will eventually do for drug addiction what SSRI’s like Prozac did for depression: convince both primary-care physicians and the public that addiction is a chronic brain disease, not a character flaw.

The physician-reporter in the CBS piece says:

The hope is that one day Suboxone can do for painkiller addiction what drugs like Prozac did for depression: convince people that it’s more of a brain disease, not so much a character flaw.

Total Score: 1 of 10 Satisfactory

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