Responding to negative press: Methadone, buprenorphine targeted
April 8, 2013

Every several years — sometimes every several months — a negative series targeting addiction treatment appears in some news outlet. Methadone and Suboxone have come in for the most negative articles. ADAW talked to public relations experts connected with addiction treatment to find out how to best respond to negative press.

Bob Weiner is one of the veteran public relations experts in the addiction treatment field, starting as the press officer for the House Select Committee on Narcotics in the 1980s, then moving to the Office of National Drug Control Policy (ONDCP) under Barry McCaffrey, and finally to CRC Health Group, where he is now. “There’s an enormous bias against methadone — people see it as a drug that keeps you addicted,” said Weiner, noting that even Congressman Charles Rangel, who headed the Select Committee, was biased against methadone. “You have to work very hard to keep these people informed.”

Typically, the origin of the negative story is diversion — sometimes only one case of it. What treatment providers know is that the one case can lead to an outcry that is simplistic and political, ending in limiting or shutting down treatment for the thousands of patients who, without it, will have no recourse. This would not be done to people with diabetes or cancer, yet it is done to opioid addicts.

And despite the good news from patients that is delivered to these reporters, that message doesn’t get published, said Weiner. “We know that state authorities and licensing people and parents and patients and families have all told reporters the positive things that happened in the lives of their loved ones,” said Weiner. “Reporters ignore that and go straight for the occasional problem.”

“It’s tough, because the country has a free press,” said Harriet Ullman, a Massachusetts-based public relations consultant who worked for many years on the Suboxone account at Feinstein Kean. “Even if they have an agenda, like getting rid of a politician, they can say what they want.”

Ullman recalled the Baltimore Sun series suggesting that the federal government was hiding the fact that Suboxone is abusable, which portrayed the use of the medication in the Baltimore system as a coverup and conspiracy (see ADAW, December 24, 2007; March 3, 2008). “I interacted with the reporters,” Ullman told ADAW. “I spent tons of time with them. I would draft potential answers and send them to people at Reckitt, and Reckitt put one of their senior people — Ed Johnson — on this.”

The reporters actually went to Johnson’s house — she recalls many of the details of this harrowing episode — and produced a video they had never asked permission to take, she said. “You could tell by the angle it was from a tie camera or something,” she said. “The reporter was so hateful, but our response was to be as open as we could be, consisting of giving him the same message, that there are thousands of people being helped, and you can’t throw it out because some people engage in illegal activity.”

The problem with negative stories, said Mark W. Parrino, president of the American Association for the Treatment of Opioid Dependence (AATOD), is multifold — more stigma for patients and more fodder for regulators and lawmakers who are philosophically opposed to methadone. There are already states trying — against all science — to limit methadone and buprenorphine treatment to one or two years. In all cases, limitations are in those states that do not want to put public money into methadone treatment.

Help from the ONDCP?

Parrino hopes that the ONDCP, given all the challenges from states, could “take on broader support for medication-assisted treatment,” he told ADAW. “Buprenorphine is coming under increasing and sustained attack, although not on the same level as methadone,” he said. “The only way out is if the ONDCP can muster the agencies to support this.” Michael Botticelli of the ONDCP will be speaking at the AATOD conference this fall.

Indeed, there was a time when the ONDCP did help, specifically, when New York City almost put an end to methadone treatment. “Sometimes you have to play hardball,” said Weiner, recalling the years when New York City Mayor Rudolph Giuliani “wanted to kill methadone treatment.” McCaffrey, then the head of ONDCP, spoke at the AATOD national meeting, and in conjunction with that issued a study that the ONDCP had conducted on the efficacy of methadone treatment. “We went to Christopher Wren at The New York Times with the study,” said Weiner. After the Times published the story on the front page, Giuliani “started softening a little,” said Weiner. It helped that the city’s police and health commissioners were in favor of methadone treatment, knowing that it was what stood between them and a heroin resurgence.

In the case of the Baltimore Sun stories, the Substance Abuse and Mental Health Services Administration (SAMHSA) also came to the rescue, sponsoring a two-day “media roundtable” on buprenorphine that was aimed at educating the Baltimore Sun reporters. There has been no such response to recent methadone stories (see sidebar).

"I have thick files of negative methadone stories — I’ve kept them all." -- Mark W. Parrino
Mind-heart splits

“I’ve dealt with this constantly for 35 years,” Parrino said. “I have thick files of negative methadone stories — I’ve kept them all.”

From Parrino’s perspective, there are two “mind-heart splits” that are a common thread throughout all of these stories. “Even when you can get someone to understand that addiction is a disease, and that methadone is needed to treat it, they don’t think it should be given indefinitely,” he said. “The next split is that it shouldn’t be given to people if there is profit.” In fact, more than 20 years ago one single state agency director said there shouldn’t be any proprietary opioid treatment programs (OTPs), said Parrino. “My response then — and it’s the same response to people today — is that you need to make sure your state provides adequate public funding.” Otherwise, private programs are the only alternative to no treatment.

Silence is not golden

The worst thing to do is to say “no comment,” public relations professionals Weiner and Ullman agreed. “Never run from a fight,” said Weiner. “Give the information. Even if the reporter is biased, the most surprising thing can happen — they actually write something positive.”

This is what happened when a news article about people dissolving Suboxone, painting pictures with it and sending the pictures into prisons for the inmates to lick went viral. Ullman handled this by responding to reporters that this was not endorsed, but she went beyond that. “I told them, ‘Let me give you a patient, and a doctor, to talk to; here’s someone who has reclaimed her life on Suboxone; here’s someone who was an addict and is now a mom with twins.’”

However, if it becomes clear — after months of working with a reporter, with many hours spent giving information — that there won’t be any attention paid to your information, don’t continue to waste time, Weiner and Ullman said. Sometimes the agenda of reporters has little to do with methadone, but methadone is an easy target, and the reporter may have a political agenda, they said.

But no matter how difficult, you need to keep responding to questions with facts — just don’t go overboard. “Every crisis is different,” said Ullman. “You want to respond appropriately but not to overrespond, because you can easily bring more fire onto yourself if you overreact.”

For example, do not put out a press release, because that makes a program look defensive, said Ullman. And definitely do not have a press conference to “set the record straight” — that’s “a lot of money for little payback,” she said.

The reporter may not be very “persuadable,” said Ullman. But keep responding with facts, she said. “At some point in the future there may be some benefit,” she said.

In fact, that is exactly what happened with the Baltimore Sun. “I did send them a lot of information, and they weren’t stupid,” she said. “None of what I sent came out in the series of five because they knew what they were going to say before they wrote it.” But a few months later the story came up again. “Lo and behold, they started putting in the arguments I had given them,” she said. “They said that you don’t want to make this inaccessible to the people who need it — you’ll doom other people to not being able to have treatment.”

There are financial issues as well, in for-profit companies, said Ullman. “You wouldn’t have the chief financial officer talk to the press,” she said. “But if you aren’t handling this well, you could get a shareholder lawsuit for running the company badly.”

Parrino, who as an association president doesn’t have to worry about shareholders but does have to worry about his members, has spent hours with reporters bent on negative agendas. These reporters “do not absorb information,” he said. “They argue with me. Why are they calling me if they don’t think I have credibility?” •

Also see the From the Field article on biased journalists (www. feature-detail/handful-of-biasedjournalists-threaten-treatment-industrys-good-work.aspx) in ADAW, October 1, 2012.