Poop! It’s funny! So when White House Press Secretary Josh Earnest was asked to comment on a Super Bowl opioid-induced constipation “awareness” ad, paid for by the pharmaceutical companies which spent hundreds of millions of dollars to acquire a new constipation drug for painkiller users, soft giggles rippled through the press pit. Drug companies profiting off drug users who can’t poop! Poop is funny, but this is bad. The White House is on it! Sort of.


Opioid-induced constipation is a real problem. Opioids like oxycodone (OxyContin, Oxynorm, OxyNEO) and heroin (smack, dope, junk) bind to receptors in the brain that inhibit the perception of pain, but also to receptors in the gastrointestinal tract. Not only is constipation a common side effect—it can be so frighteningly uncomfortable that chronically ill users forgo medication.

In the black-and-white Super Bowl ad, a nicely dressed middle-aged man watches as other people leave, beaming, from public bathrooms. A dog squats by a tree, looking mockingly into his eyes. The man is sad. Information for an “awareness” website (whose traffic jumped 400% after the Super Bowl) appears. That’s where the pharmaceutical companies AstraZeneca and Daiichi Sankyo tell you to ask your doctor about their hot new drug, Movantik.

All the non-profit pain advocacy group logos at the end of the ad might suggest this is purely an “awareness ad”, but AstraZeneca didn’t go on Super Bowl to fight constipation stigma at $166,666 per second. The LA Times:

Advocacy groups that put their names on the Super Bowl ad said the grants they received from AstraZeneca did not require them to do so and were for other educational projects...

Penney Cowan, head of the American Chronic Pain Assn., of Rocklin, Calif., said her group — which received at least $175,000 in grant money from AstraZeneca in 2015 for promoting awareness of opioid-induced constipation — would not have endorsed the ad if it directly promoted the drug.

A delicate, though lucrative distinction—officially, the “awareness” ad only directly promotes the website that promotes the drug that will treat the side effects of another drug. The opioid constipation treatment market is estimated to reach at least $500 million by 2019, according to the research firm GlobalData.

Earlier this week, White House Chief of Staff Denis McDonough criticized the ad for “fuel[ing] opioid addiction” instead advocating addiction treatment, an initiative of the Obama administration. To that end, last week President Obama said he would push forward a $1.1 billion bill to expand treatment for the country’s booming opioid addiction to painkillers and heroin. And epidemic-themed statistics are surging: An estimated 2.2 million Americans need treatment for opioid abuse; some link 28,648 deaths to opioid overdoses (18,893 specifically to prescription painkillers) in 2014; painkiller prescriptions are up least 300% since 1999. In 2012, 259 million prescriptions were written for painkillers in 2012 (overwhelmingly in the South), at a rate the CDC catchily refers to as “enough for every American adult to have a bottle of pills.” And in New York, tipped off by the skyrocketing rate of prescriptions in Staten Island, the State Attorney General’s office investigated OxyContin manufacturer Purdue for aggressively courting and encouraging healthcare providers to prescribe their drug to patients. But what are we going on about? These are, like, totally unrelated things, according to Dave Fredrickson, AstraZeneca’s vice president of specialty care.

This condition, which affects millions of Americans, is something we needed to raise awareness and dialog about. I think that is separate and distinct from the topic around the appropriate use of opioids.

McDonough’s tweet suggested that the White House wasn’t happy with the ad. That’s a rare statement since the administration has been slow to admit that overprescribing of painkillers is a cause of the opioid abuse crisis. When asked by the press if the criticism meant they were planning to “push back” on the pharmaceutical companies for their marketing tactics, Earnest said that’s not really part of the plan right now.

I don’t have any regulations to preview but I think we have been quite clear across the administration about our determination to confront opioid addiction as a significant public health threat.

He went on to say a few more words about their “prioritizing the treatment of individuals who are suffering from this kind of addiction.” But they’re going to need some help.

We want to make sure that we can mobilize necessary resources to confront it but that’s also going to require working closely with medical experts including the pharmaceutical industry to get this problem under control.

That is to say, they’re going to need some help from the dealers.

Image via AstraZeneca. Contact the author of this post at marina.galperina@gawker.com.