I was dependent on opioids. For a week. Two summers ago, following foot surgery, I experienced excruciating, constant pain that made four childbirths—including one C-section recovery—seem like an inconvenient headache. I took the opioid painkiller that my surgeon provided. It didn’t erase the pain but it did make it slightly more bearable. After a week, I finally felt better enough to switch to extra strength Tylenol. When I made that switch, I felt absolutely awful. Nausea, tiredness, sweats, depression, etc. At first, I thought it was the flu but that made no sense because I hadn’t left the house at all and no one in my house was sick. Then I started to put two and two together and I did some research on the symptoms of opioid withdrawal. With the exception of opiate cravings, I had them all. I was shocked that this happened after taking prescribed painkillers for just one week.
As I reflect on that experience, I get more and more angry about how many times I’ve been offered a prescription for opioid painkillers (more than I can count thanks to a string of dental issues) and how many times I was counseled about the risks (zero). As a well-informed health consumer, I was aware of the risks and refused to take those pills until the pain got too severe after my surgery. But there are millions who are unaware and are at high risk of falling victim to opioid dependence. According to Scientific American, more than one third of U.S. adults—92 million people were prescribed opioids in 2015. And, the U.S. Department of Health and Human Services reports that that same year, two million people had a prescription opioid use disorder.
On Thursday, President Trump is expected to declare the opioid crisis a national public health emergency and address the nation with a plan for combatting the epidemic. As reported in The Washington Post, the administration-wide effort will likely involve a massive advertising and public relations campaign. That’s welcome news, but I hope there’s more, because making a significant impact on this wicked problem will require a fully-integrated approach rooted in the principles of social marketing.
Social marketing—not to be confused with social media marketing—is a proven approach used for more than 40 years to improve public safety, environmental responsibility, financial literacy, public health, and more. At its foundation, social marketing requires the identification and deep understanding of priority audiences and the specific behaviors that are desired for each of them to positively impact the issue at hand. It requires the identification of deep, meaningful insights into each of those audiences to uncover opportunities to influence their behavior. And it requires the strategic application of the tools of marketing: product, price, place, and promotion.
Having spent my career in marketing and communications agencies that specialize in social change, I believe strongly in the power of promotion. I have seen first-hand how carefully crafted messages, delivered in a creative way by trusted messengers and communications channels that reach the audience directly have made meaningful impacts in HIV/AIDS prevention, heart disease prevention, vaccine promotion, cancer prevention, and more.
But I also know that sustained behavior change is so much more likely when other elements are included, as the discipline of social marketing outlines. For the opioid epidemic, this should include:
- Product development, perhaps supported by incentives for pharmaceutical manufacturers and our nation’s top scientists, to research and develop effective and less addictive pain medications;
- Product accessibility, such as enabling over-the-counter sales of drugs that reverse an opioid overdose, allowing more doctors to prescribe drugs that help to reduce the withdrawal symptoms of someone with an opioid dependence, and broadening the use of methadone and buprenorphine in conjunction with counseling to help people overcome addiction, as FDA Commissioner Gottlieb suggested on Wednesday;
- Price incentives, such as enhancing reimbursement policies for treatment centers; and
- Education, delivered consistently in all of the places that are relevant to the priority audiences impacted by this epidemic, such as:
- For health providers, dentists, and pharmacists: at professional conferences and through CME/CE programs (where providers can learn how to prescribe differently and counsel patients effectively)
- For consumers: at hospitals and health provider/dental offices (where prescriptions are provided), schools (where parents can be encouraged to dispose of or lock up leftover pills in their home), and places of worship and community group meetings (where discussions and workshops can be held).
Over the last 40+ years, social marketing has contributed to efforts to reduce drinking and driving, increase rates of life-saving health screenings, increase blood and organ donation, and reduce smoking and tobacco use. And the list goes on. For sure, policy and law enforcement strategies also played a role in these success stories, but alone, they stop short at the key to sustained success: changing behaviors. Making a meaningful impact on the opioid crisis requires a social marketing approach. I hope that will be at the center of our nation’s response.