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The Super Bowl ad about opioid constipation made perfect business sense for the pharmaceutical company that paid for it.

Stashed in: Awesome, Drugs!, Medicine, Advertising, Big Pharma, Vice, Opioids

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In reality, however, the ad would seem to make perfect business sense for AstraZeneca, the pharmaceutical giant that produced it. Prescriptions for opioid painkillers like OxyContin, Vicodin, and Percocet have skyrocketed in the United States over the past 25 years, going from 76 million prescriptions in 1991 to 207 million in 2013, according to the National Institute on Drug Abuse. American doctors handed out enough painkiller prescriptions in 2012 for every single adult in the US to have a bottle of pills, according to the Centers for Disease Control and Prevention (CDC).

The trend has had two consequences. The first and most alarming has been a dramatic rise in the rates of opioid addiction and fatal overdoses. According to the CDC, nearly 2 million Americans abused prescription painkillers in 2013, and overdoses now kill an average of 44 people every day in the US. The number of unintentional overdose deaths from prescription pain relievers has more than quadrupledsince 1999. Many prescription pill abusers have also turned to heroin, which has its own deadly consequences.

The second side effect is that many of those people on painkillers are having a hard time going to the bathroom. To block pain, opioid drugs deliver molecules that bind perfectly to receptors found in the brain, spinal cord, and digestive system. When opioid receptors in the bowels are affected, however, it leads to wicked constipation.

This is a common problem, as AstraZeneca found when it commissioned a study last year that surveyed 2,797 US adults who were prescribed opioids to manage chronic pain. More than a third of them (1,001 people) reported being constipated — often to the point that caused them to miss work or skip social functions. Extrapolate those figures out to the entire opioid-consuming nation, and you end up with a whole lot of severely constipated Americans seeking relief.

The obvious solution would be for users to stop taking so many opioids — but the drugs are highly addictive and cause intense withdrawals when users try to quit. With that in mind, AstraZeneca came up with an extremely lucrative solution: A pill to solve the problem caused by other pills. In September 2014, the US Food and Drug Administration (FDA) approved a drug from the company called Movantik, which prevents opioids from blocking bowel receptors.

Movantik became available to the public last March, and one site that tracks the pharmaceutical industry estimates that it and similar drugs to relieve opioid-induced constipation will be a $1.98 billion market by 2017. With those kind of profits to be had, AstraZeneca spending a few million dollars for a minute of high-profile Super Bowl airtime starts to seem like a wise investment.

Still, the ad, which was reportedlydirected by Lenny Dorfman, who previously worked on commercials for Nike and Coca-Cola, struck a chord of outrage with some Super Bowl viewers. President Barack Obama's chief of staff weighed in, as did police in Burlington, Vermont, a city hit particularly hard by opioid addiction.

Arms dealers sell the problem AND the solution.

I have to say that this is a "solution" that probably shouldn't exist because the side effect is a significant deterrent to addiction. When I had brain surgery they had me on copious opioids and I begged my doctor to switch me to some other painkiller because the side effects were so nasty. :/

You've convinced me that selling something that makes opioids more palatable is a bad idea.

It's amazing opioids are as popular as they are given those side effects.

Plus opioids don't work that well for many types of pain!

I had a close friend who had cancer in his spine and polyneuropathy, and he STILL chose to wean himself off opioids because he felt they didn't relieve long-term nerve pain as well as ibuprofen and hot baths. And even for the type of pain opioids are supposed to be best for -- like after you get your skull cut open -- I didn't think it was any better than the alternatives.

I didn't realize how ineffective opioids are for many types of pain.

Earlier this month Elizabeth Warren asked the CDC to consider legal marijuana as an alternative:

Opioid prescriptions have been skyrocketing since the early 1990s:

That's when pharmaceutical companies introduced powerful new painkillers such as MS Contin and Oxycontin and medical groups began calling pain the "fifth vital sign" that doctors should attend to. 

prescription opioids chart

The increased acceptability and commonness of opioid treatment led to an explosion in prescriptions, as well as the development of “pill mills,” shady pain clinics whose sole purpose was to prescribe legal opioids without asking too many questions. 

Before long, the US was flush with opioids; by 2011, 219 million opioid prescriptions were being handed out each year.

When the prescription-painkiller crisis became apparent, state, local, and federal law enforcement cracked down on prescribers and patients who used prescription opioids, according to Grant Smith, deputy director of national affairs at the Drug Policy Alliance, a nonprofit that advocates for drug-law reform.


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