Agenda-Setting the Heroin and Prescription Opioid Epidemics: Comparing State Media Salience and Overdose Deaths

Background: Policy agendas influence and are influenced by media coverage of social and health problems, including heroin and prescription painkiller abuse. Heroin and prescription opioids have and continue to receive growing attention from the media, policymakers, and health services delivery field. This has been attributed to the steadily growing increase heroin- and prescription opioid-related overdose deaths since 2000. Between 2000 and 2014, rates of death for both heroin and prescription opioid overdose have more than doubled – from 6.2 to 14.7 for every 100,000 deaths. The past several years have witnessed the largest increase in rates of drug-poisoning deaths. However, the extent to which policy and media responses during this time period accurately reflect the scope of such problems is unclear.

Methods: This study examined the salience of media coverage and epidemiological patterns of heroin and prescription painkiller abuse across states in 2013-2014. We examined the top four newspapers by readership and identified national-level articles’ coverage of state-specific heroin and prescription opioid problems. In reviewing articles, content analysis was used to ascertain the frequency, framing, and populations of focus. More specifically, we examined the opioid drug discussed (heroin, prescription painkillers, or both); the primary focus of the article (prevention, treatment, public health, criminal justice); valence of article's perspective towards drugs and drug users (negative or positive); geographic focus (statewide, urban, suburban, rural); population (drug users, treatment clients, physicians, pharmacists, other prescribers); gender; and race; among other factors. Further, tabulations of these content categories were compared to Center for Disease Control and Prevention mortality statistics to assess their degree of concordance.

Results: Although variability exists across states, overall there has been a 6.5% increase between 2013 and 2014 in drug overdose deaths. The greatest increase has been among men between the ages of 25-34 living in the Midwest. Although there was a comparable increase in the rate of death for White and Black, non-Hispanic individuals from 2013 to 2014, White, non-Hispanics have a higher rate – 19.0% compared to 10.5% in 2014.  Our content analysis revealed that frequency of media coverage was positively correlated with significant increases in overdose deaths. Media attention from 2013-2014 was focused mainly on the prescription opioid epidemic including the policies and interventions taking place to curb abuse. States that had more media coverage showed correspondingly greater legislative response including addressing prescribing practices, improved monitoring of drug-seeking behaviors, and interdiction efforts. Some media attention was also paid to growing heroin problems among New England, Appalachian, and Western states, in predominantly White suburban and rural locales, and among areas that had few previous heroin problems.

Implications: Our initial findings highlight how the nature and extent of media coverage of heroin and prescription opioid problems has an impact on the policy agenda-setting process and consequently on substance use disorder treatment and coverage. As states initiate efforts to address this drug epidemic, continued research is needed to understand the success of these initiatives and the how well they correspond to the needs of the population.