Innocent Addictions: Discourse Analysis of Media Coverage of Pharmaceutical Dependence in Australia

Abstract

Media coverage of non-medical pharmaceutical use has consistently presented it to be a “different” kind of drug problem, one that involves substances not typically thought of as drugs of abuse or addiction and among people not normally associated with illicit drugs and the “criminal addict.” Though differential media treatment of dependence on criminalized drugs versus pharmaceutical products is well documented in the North American context, less is known about how the Australian media covers the issue of pharmaceutical dependence. In this study, we conducted a discourse analysis of Australian media articles between 2018 and 2023 that covered dependence on pharmaceuticals. We found that media accounts use discursive frameworks to speak about pharmaceutical dependence that differentiate it from “drug addiction,” or from the way dependence on criminalized substances are typically constructed as a social issue. Media stories present pharmaceutical dependence as a “hidden problem,” made up of those unlikely to become addicted to drugs, people who are suffering genuine physical pain and for whom medical systems of care have failed. These emphasized differences are notable in part because they contradict the claims made by the now popularized bio-medical model of addiction, that addiction does not discriminate, that it is a disease that can impact anyone, and that its effects on individuals are universal. This paper draws on critical addiction studies and the sociological concept of iatrogenesis in order to highlight the power relations and political judgments involved in media representations of pharmaceutical dependence, especially that which arises in the context of medical treatment. Despite seemingly progressive attempts to destigmatize addiction in this media reporting, we demonstrate how the examples used to illustrate the issue draw on long discursive histories which associate whiteness with innocence and reinforce the unquestioned benefit of contact with the medical establishment.

Introduction

The misuse of prescription drugs, especially opiate painkillers and benzodiazepines, has achieved recognition as a social problem in Australia over the past decade. Its visibility as a pressing issue has been heightened by the North American overdose crisis, in which pharmaceutical opioids have played a central role (Webster et al., 2020). While Australian patterns of use are different from those in the United States, there has been a steady increase in the prescription and dispensing of pharmaceutical opioids over the past three decades, consistent with increasing concern about the risks and harms of these substances (Blanch et al., 2014). For example, in the state of Queensland between 1997 and 2018, the number of medical practitioners prescribing opioids quadrupled and the number of patients being prescribed opioids increased 11-fold (Dunlop et al., 2021). Since 2008, there has been an increase in overdose deaths related to pharmaceutical opiates, driven in part by the emergence of fentanyl in Australia (Roxburgh et al., 2017).

These trends have spurred government concern and investigations into the impact of medication consumption in the community. In an early report on pharmaceutical-related harms, the state parliament of Victoria observed that:

The most telling part of our investigations was the realisation that many people within the community do not perceive prescription drug abuse to be a form of drug abuse. (Drugs and Crime Prevention Committee, 2007, p. 2)

The report framed non-medical pharmaceutical use as a serious “drug problem” that involved substances not typically understood to be “drugs of abuse.” In the more than 15 years since this report was released, sustained public interest and policy attention on the non-medical use of pharmaceuticals have maintained the idea that this is a social issue that cannot be understood by conventional thinking about drug use (Dertadian, 2019). This kind of framing of the issue has informed government responses such as the introduction of real-time prescription monitoring systems (Picco et al., 2023). These systems are compatible with Australia's public health insurance system (Medicare) and its pharmaceutical benefits scheme, which provides (and controls) access to approved medicines. They aim to prevent dependence by identifying “doctor shopping” and “diversion” (Boyles, 2019).

Given this increased concern and policy developments around pharmaceutical use in Australia, research on media representations of the problem is timely. In this paper, we follow recent US research by exploring the representational strategies used in Australian media stories about dependence on pharmaceuticals (mainly opioids). We draw on the insights of critical addiction studies and employ discourse analysis to examine how Australian news media coverage frames dependence on pharmaceuticals and differentiates it from ordinary addiction. In particular, we build on previous Australian research which has demonstrated that news reporting is characterized by “surprise” that “non-traditional” users are dying by pharmaceutical-related overdose (Dertadian & Rance, 2023). We focus on representations of those who have become “addicted” to prescription drugs in medical contexts, highlighting the contrast between their constitution as innocent victims and the continued stigmatization of people who use criminalized drugs. We also examine how the problem is constructed as a systemic rather than individual failure. Our analysis therefore contributes to an understanding of the differential politics of addiction and pharmaceutical consumption and the role of the news media in naturalizing distinctions between blameless and blameworthy subjects.

Approach

In conducting our media analysis, we draw on two key conceptual approaches: critical studies of addiction and sociological accounts of iatrogenic harm.

Critical Studies of Addiction

Our paper builds on and contributes to the critical study of addiction, which understands it as a culturally specific set of ideas and practices that shape different problems of consumption and conduct into an individual disorder (Fraser et al., 2014, p. 26). This approach does not deny that people can face struggles with their substance use and experience serious harms as a result, rather it highlights the discursive reduction of heterogeneous physical, psychological, social, and legal effects to individual pathology. Critical perspectives highlight that addiction is a hybrid entity made up of medical and moral judgments about self-control and ideals of healthy, productive living (Keane, 2002). Indeed, addiction cannot be separated from the politics and power relations that constitute it as a personal and public policy problem (Ritter, 2021). These politics of addiction knowledge and practice are especially evident in relation to colonial narratives (Dertadian, 2024), color-blind racism (Matsuzaka & Knapp, 2020), and systems of class relations (Hansen et al., 2023).

Our research is also motivated by a broader interest in how drugs and their use are classified according to moral and political judgments, including attributions of blame and culpability (Fraser et al., 2014; Seddon, 2009; Seear, 2019; Tupper, 2012). In particular, opiates have a long history of demonization as powerful foreign agents of disorder, which exist alongside their status as valuable analgesic medicines (McCradden et al., 2019). This dual status is reflected and reproduced in the DSM-5 diagnostic criteria for opioid use disorder, in which symptoms of physiological dependence (withdrawal and tolerance) are explicitly not applied to “individuals taking opioids solely under appropriate medical supervision” (American Psychiatric Association, 2013, p. 541). The distinctions between normal dependence and disordered addiction, between beneficial medications and dangerous drugs, and between legitimate suffering patients and drug-seeking “addicts” have been central in the medical management and government regulation of these substances (Dertadian, 2019). However, the North American overdose crisis has challenged the clearcut differentiation of beneficial medications from dangerous drugs by highlighting the harms of increased prescription of pharmaceutical opiates for chronic pain. The crisis has also undermined confidence in the ability of “medical supervision” to prevent addiction.

This critical approach has demonstrated how the problem of pharmaceutical “abuse” is shaped by addiction science's attempt to differentiate between the “normal” use of opiates under medical supervision and the “pathological” use of these medications when compared to other criminalized opioid substances (such as heroin) (Compton & Volkow, 2006; Volkow et al., 2004). As a result of this history, addiction science and pain medicine have developed terms such as “pseudoaddiction,” “therapeutic dependence,” and “chemical coping” to avoid the unnecessary stigmatization of pain patients. These terms emphasize contextual detail such as the undertreatment of pain (Passik & Kirsh 2004), genuine fear that patients will run out of their medication or that their condition will worsen (Littlejohn et al. 2004), and medication (ab)use to manage the stress and anxiety associated with chronic pain (Kwon et al. 2014). In this way, kinds of pharmaceutical consumption are differentiated from “true addiction,” which is “characterized by aberrant behavior, craving and loss of control” (Keane and Hamill 2010, p. 58; Bell & Salmon, 2009). Our analysis highlights the way these normative distinctions are reflected and reproduced in media accounts, particularly through the genre of personal stories of pain and medical mistreatment.

Iatrogenic Harm and the “Opioid Crisis”

Sociological research has drawn on the notion of iatrogenesis to critique the way pharmaceutical consumption is presented as safe(st) under medical supervision. As part of his influential early account of “the medical establishment” as a threat to health, sociologist Ivan Illich conceptualized iatrogenesis as a broad-ranging phenomenon of medically produced harm, taking clinical, social, and cultural forms (Illich, 1975). Recent analyses of iatrogenesis have explored how the “nemetic character of contemporary biomedicine—whose growth in technique has meant a corresponding growth in its capacity for corruption and harm” (Ashe, 2021, p. 255) is commensurate with the ever-expanding pharmaceuticalization of everyday life (Bell & Figert, 2012).

The notion of iatrogenic addiction, that is, addiction caused in the course of medical treatment, was foundational to the classed and raced distinctions that shaped the early development of addiction as a recognized medical condition (Acker 2002, p. 29–30; Conrad & Schneider, 1980; Kolb, 1962). However, the concept of iatrogenic addiction has taken on a new resonance and urgency in the context of the North American opioid crisis (Jannetto, 2021). Researchers have highlighted the iatrogenic effects of opioid-based pain treatment, highlighting multiple deleterious consequences, including addiction and death (Chary & Flood, 2021). Indeed, investigations into the role of the slow-release opiate medication OxyContin have focused on the exploitative and corrupt marketing of the medical establishment, as well as the cavalier approach of some physicians to patient well-being.

Of particular relevance for our paper is Textor and Schlesinger's work on the governance of risk and iatrogenic harms (2021). They discuss the case of Susan, a chronic pain patient who was prescribed opioid medications following a car accident. They explain that her “gender, class, and racial positioning” as a white woman enabled her to access effective and long-term treatment with opiates, but this was destabilized when she was re-categorized as a “high-risk” user following dramatic changes in US prescription guidelines and insurance coverage (p. 246–247). Her subsequent banishment from medical care exposed her to multiple serious harms as she transitioned to heroin when forced to self-manage her pain (Brown & Morgan, 2019). As Textor and Schlesinger highlight, producing demand then restricting supply places patients in an iatrogenic double bind, “Policy interventions implemented to reduce opioid prescribing shore up the legitimacy of biomedicine in managing risks to patients, while neglecting to consider the risks of medical abandonment and its iatrogenic consequences” (p. 247). We employ the notion of iatrogenesis in our analysis to explore how the problem of pharmaceutical dependence is framed in the media. Our focus is on clinical iatrogenesis, specifically the harm resulting from medical treatment and the limits to its recognition in the framing of “innocent addictions” in media accounts of dependence on pharmaceutical drugs.

Methodology

We conducted multiple searches of the Factiva ¹ database, starting with the search terms “pharmaceutical” AND “addiction” OR “addict” OR “dependence” OR “dependent”—this search was repeated with synonyms for pharmaceutical, such as “medication” and “pill,” and the names of relevant medication categories such as “opioid,” “opiate,” “benzodiazepine,” and “antidepressant.” The search was conducted on September 7, 2023, and was restricted to 5 years previous to this date. It produced 46 articles that were then subject to the following inclusion and exclusion criteria. Articles were included in the sample only if they focused explicitly on pharmaceutical use or dependence—this meant that articles that were about other medical issues but included a single mention of addiction, or which discussed addiction in the context of a film were not included. Articles were included in the sample only when they were produced by a public-facing media outlet—for example, press releases and professional association publications whose audience is not the general public were not included. Finally, articles which focused on the lives of celebrities were excluded because a determination was made that these stories were in a specific celebrity culture genre and were concerned with a discrete set of personal problems not comparable to the broader discourse around the issue.

The resulting data set contained 24 articles from 16 media sources. The publications included tabloid (11), regional (8), online only (4), and national broadsheet (1) publications. Within the sample, six articles contained some content that was repeated or crossed over with another article in the sample—this includes two specific stories of addiction that appeared in multiple news articles in different forms. It is also worth noting that while our search terms used broad terminology to capture a wide range of pharmaceuticals, the resulting sample and the content of the articles refer almost exclusively to prescription medications and specifically to opiates and benzodiazepines. This relatively contained data set enabled us to carry out the in-depth consideration of each text required for effective discourse analysis.

Discourse analysis is concerned with the construction of objects and subjects (such as addiction and addicts) within broader “regimes of truth” (Foucault, 1980). Therefore, we understand representation as an active process of construction, in which language constitutes social reality (Campbell, 2016). Discourse analysis is well suited to investigating drug-related topics in the media because it is explicitly concerned with the relationship between the construction of meaning and the operation of power (see Cook et al., 2023 and Clinnick et al., 2020 for recent examples). For instance, research employing discourse analysis has demonstrated that addiction is produced in multiple forms in media accounts, as bodily decay (Huggins, 2006), as badness/sickness (Tiger, 2017), and as a journey of loss and redemption (Daniels et al., 2018).

The discourse analysis we conducted was guided by the following research question: How is addiction represented and constituted in Australian news media coverage of pharmaceutical dependence? Our analysis followed an iterative process involving multiple close readings of the texts. The first reading, led by the first author, focused broadly on how the problem of pharmaceutical dependence is framed. Consistent with existing literature, we found that the differentiation of pharmaceutical dependence from “drug addiction,” especially as related to criminalized substances, was a central discursive device. We then reread the articles focusing on this element and were able to identify repeated ideas, rhetorical devices, metaphors, and structures of argument. The third author led the process of organizing these discursive features into the themes which guide our analysis below. Guided by the third author's reading, we also focused on absences in the texts, as discourse operates by both producing and excluding possible meanings. Each author read the articles independently before we discussed and reflected on our findings as a team. The final stage of analysis was critical interpretation of the themes, taking into account the broader discursive field of addiction and drugs.

Findings and Discussion

There was a pattern in the type of news venues which featured stories about pharmaceutical dependence. As noted in the Methodology section, our data set was dominated by articles in tabloid and regional newspapers. There were only a small number in national broadsheets and more widely distributed major city newspapers. While we cannot determine the reasons for this pattern in our analysis here, it is consistent with relatively higher rates of overdose in rural and regional communities in Australia (Penington Institute, 2023). What is harder to determine is who and how many people who use pharmaceutical opioids are dependent on them. Rates of diagnosis, emergency room presentations for withdrawal, and demand on treatment services are not generally considered reliable measures for who is experiencing opioid dependence (Downing et al., 2023).

The concentration of regional newspapers in our sample is also consistent with earlier Australian research which found that tabloid newspapers tended to publish a higher volume of drug-related stories (Lancaster et al., 2012). In addition, the evaluation of newsworthiness in local and regional journalism is likely to be more focused on notions of social and personal connection and less on national and international significance (Bowd, 2011).

A Hidden Health Problem

The media texts represent pharmaceutical dependence as a significant and harmful phenomenon requiring urgent government action, thus locating it within a familiar “social problem” frame (Clarke & Cochrane, 2015). The idea of a hidden problem is a frequently used discursive device in media and research texts, and the connotation is that lack of awareness of the issue exacerbates its harmful effects, and therefore, action is needed to both reveal its prevalence and to intervene effectively before the situation worsens. The social problem construct gathers diverse experiences and predicaments together into a coherent issue of concern to government and society, in this case, a drug problem. More specifically, pharmaceutical dependence is referred to as a “hidden drug problem in Australia” (The Advertiser, April 2019) and a “hidden public health issue that is growing in magnitude” (The Advertiser, December 2019). By representing pharmaceutical dependence as both a drug problem and a public health issue, the media articles reproduce an understanding of addiction as a condition properly addressed through a rational medical and health-focused approach, rather than a criminalizing or moral register.

Comparison, quantification, and juxtaposition are frequently used in the articles to emphasize the objective magnitude and potentially fatal nature of pharmaceutical dependence: “These drugs kill too” (Progress Leader, February 2019). It is presented as more dangerous than other more recognized causes of death:

Accidental drug-related death in Australia is more than double the road toll and higher than death from heroin or illicit drug use. (Wimmera Mail Times, October 2018)

There is a massive, silent epidemic happening right now that, in some ways, is as severe and harmful to the community as domestic violence, gambling, road fatalities and illicit drugs—it just hasn’t had the same awareness. (The Advertiser, December 2019)

The limited coverage of pharmaceutical dependence in national news venues suggests that there is some veracity to the claim that this “massive, silent epidemic” has not yet achieved prominence as a newsworthy crisis or threat in Australia.

Despite the public health framing, comparison with criminalized substances is a common feature of these texts. The term “illicit drugs” invokes danger, deviance, and lethality, and therefore, this comparison constructs prescription drugs as powerful substances with equal potential to harm, despite their medical legitimacy and therapeutic status. For example, one article reported that the percentage of those in South Australia who use “prescription opioids and benzodiazepines for non-medical purposes… [was] more than the use of methamphetamine, cocaine and heroin put together” (The Advertiser, April 2019), while another notes that “Prescription opioid drug dependency in South Australia has reached ‘epidemic’ proportions, killing the same number of people as illicit drugs such as heroin and methamphetamine” (The Advertiser, December 2019). It is notable that these comparisons bring dependence together with misuse and overdose as parts of a broader prescription drug use issue.

Paradoxically, the comparison with criminalized drugs constitutes pharmaceuticals as a “different” kind of drug problem, although similarly harmful in its consequences. That is, these comparisons rely on the carving out of prescription drug use as unique and distinct, while at the same time highlighting similar risks to marginalized practices such as methamphetamine use. The tone and tenor of the reporting certainly diverge from the strong emphasis on criminalization, individual moral failings, and personal trauma in media coverage of dependence on criminalized substances (Fraser et al., 2018). Coverage of dependence on pharmaceuticals in our sample includes little mention of criminal liability, the “bad” choices or shortcomings of individuals, nor the trauma they might be responding to with drug use. Instead, dependence is overwhelmingly presented as “innocent,” linked to medical conditions, happening among an unlikely and unsuspecting group of well-meaning people for whom the medical and legal system has failed. Though there were two explicit references to the term “innocent,” our analysis revealed that innocence—understood as blamelessness, lacking guilt or culpability—was a central discursive framework for understand this form of addiction in these media articles.

Indeed, analysis of US media coverage of prescription opiate misuse has identified a significant and racialized reshaping of public discourse on addiction. Sympathetic stories of the suffering of white users have disrupted the previously dominant vision of “addicts” as a threatening criminal underclass (Netherland & Hansen, 2016; Tiger, 2017). As Netherland and Hansen argue, non-medical pharmaceutical use is often “coded as a middle class White, largely suburban problem” which relies on “different representational strategies and interventions” from the use of criminalized drugs. This has produced a dominant image of pharmaceutical consumption, which “tones down” or “softens” war on drugs rhetoric (Beckett & Brydolf-Horwitz, 2020), and is therefore less supportive of criminal sanction and more focused on medical surveillance and control (Johnston, 2020; Tiger, 2017).

As we elaborate further below, innocence as it is invoked in this media coverage is racially coded as white, while also reproducing assumptions about problematic, blameworthy drug use as characteristic of an imagined “underclass” (Monaghan & Yeomans, 2016). As First Nations social science and legal scholars have argued, protection is frequently extended to whiteness in Australian media, with white subjects constructed as vulnerable and deserving of safety (Cripps, 2021; McQuire, 2019), even when involved in acts of violence (Whittaker, 2019). Here, we are thinking of race and class as systems of power which reinforce structural hierarchies and normalize white supremacy within settler colonialism (Moreton-Robinson, 2015; Stevens, 2019).

“Unlikely Addicts”

The articles represent the victims of pharmaceutical dependence as “unlikely addicts.” This construction of unlikeliness reproduces well-established dominant discourses about drug-using subjects. Media reporting of drug use often reflects long histories of the targeted criminalization of First Nations communities (Porter, 2016; Porter & Cunneen, 2020), “crackdowns” in migrant communities (Dixon & Maher, 2005; Maher & Dixon, 2001), and the presentation of queer people as particularly vulnerable to drug-related harm (Pienaar et al., 2018). As the first author has argued elsewhere, this means that “the ‘non-traditional’ drug user emerg[es] as heteronormative, White, and middle-class” (Dertadian & Rance, 2023).

The strongest articulation of the idea that pharmaceutical dependence occurs among a group unlikely to be affected by addiction is found in the personal stories of pain and dependence which are repeated in multiple articles. There are five articles on the case of “Melbourne mum” Tina and three articles that present the story of “country boy” Simon. Despite these two stories having contrasting outcomes, there are similarities in their framing. Simon tragically died after many years of prescription pain medicine dependence. Following his death, his parents lobbied for real-time prescription monitoring to combat doctor shopping. The articles which recount Simon's struggles are framed around the reforms they helped bring about and draw on their account of Simon's character and his experiences. Tina successfully recovered from her prescription drug dependence after many failed attempts and published a memoir, Mother's Medicine, on her experiences. We should make clear here that our analyses of the media representations of these individual cases do not intend to dismiss or diminish their suffering or the devastating consequences of these medical experiences. Rather, we are concerned with how specific and complex lived experiences are shaped into familiar addiction narratives.

Tina's story begins by contrasting her superficially perfect life with the reality of her desperate situation. Tina “seemed to have it all—a loving husband, two gorgeous girls and a covetable house near the beach…But she was also battling addiction” (Herald-Sun, May 2019). In the articles, the story of how Tina developed chronic pain is linked closely to the way she became a mother and its impact on her life, “After the traumatic birth of her daughter… [she] underwent an emergency C-section with no pain relief… Less than a year later, she welcomed second child Zoe, and quickly returned to her high-pressure job in the medical industry” (Herald-Sun, May 2019). Thus, Tina is an “unlikely addict” because her drug use and dependence develops from the challenges resulting from family and professional success—both connection to family and professional success are typically seen as antithetical to addiction and addicted subjects.

Several articles presenting her story rely heavily on first-person excerpts from her then recently published memoir, which one article describes as “her story of motherhood and recovery via alternatives such as yoga” (Herald-Sun, May 2019). The juxtaposition of motherhood and recovery is striking in its contrast to the way motherhood is frequently weaponized against women who use drugs in drug policy (Campbell, 2000; Flacks, 2019; Sybylla, 2001), in healthcare (Nichols et al., 2021), and in media discourse (Goc, 2007; Humphries, 1999; Springer, 2010). This material also implies that addiction can and should be treated through middle-class practices of self-care, such as attending yoga classes. This is another example of a strong contrast to the way carceral and medical control of people who use drugs is the dominant discursive frame in media accounts about how to deal with “drug addiction”—a term heavily associated with and often reserved for those who are dependent on criminal drugs (Fraser et al., 2018). These articulations of Tina's story, of a “busy mum” who “had it all,” emphasize that she is not what the reader might expect to be the face of addiction and by extension that the way to address addiction for her and those like her looks different.

Simon's story similarly emphasizes his distance from the stereotypical world of drug use. He is introduced to the reader as coming from “a happy family, growing up in the country” (Wimmera Mail Times, October 2018), which is reiterated in different ways across the articles, including through the inclusion of quotes by his mother: “We are a happy family, growing up in the country” (Ballarat Courier, October 2018). Simon is presented as a quintessentially down to earth and decent Aussie bloke: “He loved cars, skiing, shooting and above all, his daughter Maddie” (Ballarat Courier, October 2018). A significant part of the positive story about who Simon is and where he grew up includes references to him being “a gentle, fun-loving country bloke” (Wimmera Mail Times, October 2018) and “a country boy who embraced life” (The Age, February 2020). His status as from a “good” family and as young and coming from the country is directly linked to a sense of surprise that he might become dependent on drugs: “If anyone told me years ago we would have addiction in our family, I would never have believed them” (Ballarat Courier, October 2018).

Each of these reference points has discursive histories that signal to the reader how Simon should be understood, especially in relation to addiction. His youth signals his potential and an associated sense of grief at the loss of potential that addiction might bring about (Dertadian & Rance, 2023). His respectable family involves coded references to whiteness—not to being white, a detail which is not included in the articles, but to proximity to whiteness as a system of power (Johnston, 2020). Much has also been written about the performance of white masculinity in terms such as “country boy” (Putcha, 2022). The phrase invokes a sense of “natural” connection to land and authenticity tied in particular to young men living in regional areas that are at physical distance from the artifice of city life in settler-colonial societies. It is important to mention as well that the term “country” is highly contested in Australia. While it refers to regional and rural areas as defined by settler-imposed state and territory borders in mainstream discourse, notions of kin and country are fundamental to First Nations people's connection to the land and sea (Tynan, 2021). In this way, references to “country boy” in the articles resemble what Tuck and Yang (2012) refer to as “settler moves to innocence”—in which primarily white settlers seek to demonstrate a quality comparable to Indigenous peoples as part of strategies to distance themselves from colonial violence or from having to be accountable for its harms. In this way, discursive frames that invoke innocence often seek to draw attention elsewhere, such as to the suffering and systems failures that are constituted as the causes of this form of addiction.

Pain and Legitimate Suffering

The articles primarily represent pharmaceutical dependence as a consequence of the undertreatment and medical mismanagement of pain, as exemplified in Tina and Simon's stories. There are almost 150 references to the word “pain” in our sample of articles, not including separate references to “painkillers.” The reporting constructs a narrative in which addiction results from a genuine need for treatment to relieve debilitating physical suffering: “Many pharmaceutical addicts start via legitimate exposure to painkillers, such as a painful injury or chronic disease” (Shepparton News, May 2019). The mention of injury and disease is important here as it reinforces the idea that this pain is organic and therefore incontrovertibly real, unlike more diffuse forms of social and emotional suffering which might foster drug use.

Tina's story is a vivid account of the devastating impact of chronic pain and fatigue. Tina recalls that “the nerve pain rendered me dysfunctional” (Herald-Sun, May 2019), explaining that “As chronic fatigue sets in, life demands that I surrender to being sick” (Herald-Sun, May 2019). Here, pain is represented as undermining an otherwise productive and healthy life structured around responsibilities to others. The narrative highlights an innocent imperative for escalating drug use: “Then the next dose would need to be twice as much just to touch the sides of the pain. So the merry-go-round continued of pain, pill, sleep, pain, pill” (Herald-Sun, May 2019). Framed this way, continuing to take medications at the risk of dependency is constituted as a reluctant practice in a situation without better options. Paradoxically, dependence is the result of exercising agency over pain, “My willingness to medicate the pain with the opiates I am prescribed is now the only control I have” (Herald-Sun, May 2019). In Simon's case, it is a car accident which is the catalyst for his dependence. The accident left him “in a perilous condition from which he required ongoing treatment” (Wimmera Mail Times, October 2018)—the articles go on to say that as a result of this necessary treatment “Simon gradually and innocently grew dependent on his medication” (Wimmera Mail Times, October 2018).

The way physical pain is used in these articles to illustrate the legitimacy of the suffering of those described draws on the logic that rest behind terms like chemical coping and extra-medical use. Here, pain is taken seriously and presented as a legitimate reason to use opiate medications, even in the context of drug dependence. More than this, the impact of psychical pain on otherwise productive lives is implied to generate forms of social and emotional suffering, which are themselves medicalized and therefore legitimized through diagnosis like depression and anxiety. Painkillers are thus seen to continue to provide an (extra)medical therapeutic outcome, because they act as a way to chemically cope with the social and psychological consequences of physical pain. Indeed, it is the status of these individuals as “unlikely addicts” which helps to make these accounts of ongoing pharmaceutical consumption, even when they involve opioid dependence, to be presented as and to continue to register as “innocent.” Much like developments in addiction science and pain medicine, the reporting works to ensure that the people in these examples, and those who implicitly occupy the reporting of pharmaceutical-related harm more broadly, are not stigmatized as “addicts.”

Where the sample does diverge from the medical distinctions outlined in our earlier discussion of opiates is in relation to the way pain medications are described. Rather than careful construction as safe when used under medical supervision, the reporting presents pain medications as necessarily and inherently risky drugs. For instance, these substances are referred to as: “dangerous drugs” (Northside Chronicle, November 2021); “dangerous painkillers” (Wimmera Mail Times, October 2018); “exceptionally dangerous” (Shepparton News, May 2019); and “some of the most powerful opioids on the market” (The Age, February 2020). In its emphasis on the legitimate physical pain being experienced by those featured in the articles and the strength and “addictive” qualities of painkillers being used, this coverage consistently presents dependence on pain medications as unplanned and accidental. One article makes this point quite explicitly, including commentary from a pharmacist indicating that “Dependence on prescription drugs is often unintentional, [and] can be quite subtle” (Bendigo Advertiser, February 2019) and that “often becoming dependent on the drug is unintentional on a patient's part” (Bendigo Advertiser, February 2019). This articulation of addiction by accident reinforces the construction of pharmaceutical dependence as a problem that occurs among those who are otherwise unlikely candidates for addiction.

Systemic Failures and Solutions

Given that pharmaceutical dependence is articulated as caused by physical pain among a group who are otherwise unlikely to become addicted to drugs, the articles commonly present these addictions as the result of failing healthcare systems that are in need of reform. This framing is reproduced in several forms, including first person narratives: “My dependence on opioids was entirely predictable given the duration I was prescribed it for” (Herald-Sun, May 2019); reflections by those who had lost loved ones to pharmaceutical overdose: “We saw a system that was broken, and so many people were slipping through the cracks” (The Age, February 2020); expert observation by those representing large healthcare providers: “There are a lot of people with chronic pain on medication who want to get off them, and at the moment our community resources aren’t at the stage where can refer them to people who can assist them with that” (Wimmera Mail Times, May 2019); and journalistic commentary: “thanks in part to a medical system that encourages quick consultations and lacks the ability to monitor how drugs are dispensed, she was able to continue feeding her addiction” (The Age, February 2020). Within this discourse of systemic failure, an assumption is made that governments can and should be acting to interrupt the harm of pharmaceutical dependence: “knowledge of the problem has had little effect on prescribing practices and governments are under growing pressure to act before it's too late” (The Age, February 2020). In this way, the addictions in question are presented as the result of failures of the medical system, which reinforces the idea that those who suffer these addictions do so “innocently.”

This focus on poorly designed systems that produce the addictions in question is in stark contrast to the way media coverage often focuses on “bad” choices (Russell et al., 2020) and the “weak” moral character (McGinty et al., 2019) of people who are drug-dependent. Discursive frames that take system design as the cause of addiction, as described above, also invert the concern for “law and order” found in much media coverage of addiction (Afzali et al., 2022; Shachar et al., 2020). Given how central individual responsibility is to discourses of crime and criminality (Hillyard & Tombs, 2007), the deferral to system problems in the articles we examined means that the legal implications of drug dependence are rarely mentioned, and the term “crime” rarely features. In the one article where it is mentioned, crime is closely associated with the harm caused by medical practitioners. The article titled Australia’s opioid crisis: How pain management got out of control includes the statement: “As the use of opioid pharmaceuticals increased in Australia, so too did concerns about the risks of crime and corruption” (The Age, February 2020). Here, it is the misconduct of reckless medical professionals that is highlighted as the threat to law and order. In another article that mentions drug charges laid against a “Brisbane painting apprentice,” this is explained as a result of the person in question being “stung in [a] doctor's alleged pill trafficking empire” (Northside Chronicle, November 2021). Another article refers to a “Queensland doctor who was responsible for caring for the sickest kids in the state” being “caught prescribing himself powerful painkillers to feed a raging addiction which saw him pop up to 16 pills a day” (Courier Mail, December 2020). There is thus a significant difference in tone and language when the articles discuss patients who have become drug dependent compared to the representation of medical practitioners who treat those who have become dependent on pharmaceuticals. The legitimate suffering, vulnerability, and innocence of the former are contrasted with the intentional and self-interested malfeasance of the latter.

This construction of medical practitioners might in some ways be seen as consistent with Illich's account of iatrogenesis as a fundamental element of medical dominance—as pharmaceutical addictions are ascribed to medical systems and the behavior of medical practitioners causing harm is harshly judged. Yet the way the articles present emerging policy solutions is limited in terms of structural criticism of medical power. The primary way the articles frame government responses is around the launch of several real-time pharmaceutical purchase monitoring programs, including SafeScript and ScriptWise. These prescription monitoring programs are constituted as highly effective and targeted responses, “dedicated to preventing the harm associated with powerful prescription painkilling medications” (The Advertiser, April 2019) and “aim[ing] to eliminate doctor shopping, a key way patients with prescription dependence can obtain unsafe quantities of medication” (Ballarat Courier, October 2018). The articles highlight how the programs both provide information to assist health professionals while also monitoring their practices for safety. They “provid[e] doctors and pharmacists with access to prescription histories for high-risk pain and sedative medications such as opioids and benzodiazepines” (Progress Leader, February 2019) while also ensuring that “every time a doctor or pharmacist prescribes or dispenses opioids, benzodiazepines and other high-risk medicines, they will be required to record the information and check the patient's records for any red flags” (The Age, February 2020). The articles present ScriptWise and SafeScript in a positive light without exception. Indeed, these programs are presented as community and advocate-led solutions to pharmaceutical dependence, with multiple references to the support expressed by those who have experienced medication dependence and family members impacted by overdoses. The introduction of these programs is also justified by reference to the personal stories discussed above: for instance, in one article the Victorian State Government Health Minister is quoted as saying that “We've paid a high price for this to happen but we want to prevent future Simons” (Ballarat Courier, October 2018).

Key to these proposals is a centralized system that is monitored by a centralized body. This centralization is endorsed as important in addressing the way harm is distributed across the community, especially in regional “country” areas:

Health Minister Jill Hennessy said prescription drug addiction was a major, complex problem nationwide but western Victoria was a great starting point to set up the SafeScript program because there was large cities in Ballarat and Geelong and contrasting small remote locations. (Wimmera Mail Times, October 2018)

As described, these monitoring programs operate by concentrating the control of medication access in government departments and legislative bodies and away from individual clinical encounters—which those who have investigated iatrogenic harm have argued causes the most harm (Textor & Schlesinger, 2021). Somewhat paradoxically, increased access to medical services is presented as the solution to iatrogenic harm. While the endorsement of programs such as SafeScript and ScriptWise suggests a need for increased surveillance and control of both patients and physicians, this response further tightens the health system's regulatory control over drugs. The “medicalizing ideology of prescription,” as Kane Race calls it, is enhanced rather than questioned, and decisions about medications are moved further away from consumers (Race, 2009, p. 186; Temin, 1980). As Textor and Schlesinger's case study and other research has demonstrated, restrictive bureaucratic and legislative responses to the potential harms of opiate dependence can readily produce harm while failing to respond to the need to alleviate pain (Antoniou et al., 2019; Textor & Schlesinger, 2021).

No mention is made in this media coverage of the similarity this approach bears to the North American “crack-down” on “pill-mills” (Kennedy-Hendricks et al., 2016) and the double bind this placed patients in. Making opiate pain medications widely available and then significantly restricting access risks serious harms. In North America, effects have included growth in the number of people who rely on underground drug markets, transitions to heroin and injecting drug use, and the contamination of the drug market with more concentrated opiates such as fentanyl (Brown & Morgan, 2019). Regulatory processes such as prescription monitoring also ignore long histories of medical control over colonized (Richardson, 2019; Watego et al., 2021), racialized (Castro, 2020), and criminalized peoples (Frank et al., 2021; Fraser & Valentine, 2008). With these histories in view, the stated goals of prescription monitoring, such as “help[ing] GPs and pharmacists to identify developing addictions or potential black market use” (Wimmera Mail Times, October 2018) by providing pharmacists and clinicians with an alert that “a patient has earlier been ‘doctor shopping’ for drugs at another clinic” (The Age, February 2020), contain significant potential to expand the punitive social control of marginalized groups. In this way, monitoring programs can be viewed as a white and middle-class solution to what these articles present as a white and middle-class problem. The problem of dependence on pharmaceutical drugs is presented in these articles in ways that differentiate it from the race and underclass associations of popular understandings of drug addiction, and discussion of solutions reinforces this through reliance on lifestyle practices and medical systems that are more available to white and middle-class people.

What are also absent in media accounts of how best to respond to the problem of pharmaceutical dependence are any harm reduction measures or therapeutic programs which would associate this drug problem with the use of criminalized substances. The professional bodies quoted as experts in the media articles do not include harm reduction or peer user organizations. For example, Naloxone is an easily administered medication which can rapidly reverse overdose. Take-home naloxone programs have proved to be life-saving for people who use opioids (Farrugia, 2019). But perhaps because these schemes are linked to injecting drug use and peer networks of people who use drugs, they are not presented as relevant to those taking prescribed opiates. Similarly, opioid agonist therapy, using methadone or buprenorphine, is a recommended and well-established treatment for opiate dependence, but it is not mentioned in the articles. The therapeutic potential of these drugs in cases of dependence is excluded from consideration, perhaps because it would disrupt the presentation of opiate medications as uniquely and inherently dangerous.

These absences demonstrate the potential costs of disconnecting pharmaceutical dependence from the stigmatized category of “illicit drug use” and emphasizing their differences as distinct and fundamentally unrelated problems. While pain patients may be protected from stigmatization and criminalization as “addicts,” they are also separated from the forms of mutual aid and harm reduction knowledge present among networks of people who use drugs.

Conclusion

Our analysis of media representations of dependence on pharmaceuticals contributes to critical studies of addiction; in particular, it expands understandings of the diverse ways in which the condition is constituted as a health problem requiring intervention. Our work also highlights the continued ambivalent status of opiate painkillers as beneficial medicines and dangerous life-destroying drugs. We have outlined the discursive construction of pharmaceutical dependence as an urgent public health issue comparable to illicit drug use in its harms, but quite distinct and dissimilar in its etiology, its meanings, and its moral attributes. In Australian media reports, those who become dependent on prescribed opiates and other drugs are represented as innocent victims of poor medical care and the powerful substances they were exposed to as a result of treatment for debilitating pain. The personal stories chosen to illustrate pharmaceutical consumption as a public health issue are of respectable people who are otherwise stable, productive, and law-abiding citizens. These “unlikely addicts” are implicitly contrasted to the class of addicts whose illicit drug use is framed through dehumanizing discourses of crime, individual failure, and culpability.

Our point is not to suggest that those who experience dependence and other forms of serious and sometimes devastating harm related to pharmaceutical drugs are undeserving of sympathy or care. Rather it is to highlight how these representations of respectability and innocence can entrench the stigma and marginalization of those dependent on criminalized substances and therefore excluded them from humanizing narratives. For example, the physical pain resulting from a dramatic event such as a car accident is more readily framed as a legitimate reason for chronic drug use than more diffuse and ongoing experiences of debility, disadvantage, and suffering. Thus, the categories that animate implicit references to the ordinary drug user or “addict” are reinforced: namely, people of color, migrant communities, the working class and queer people, who are classified as “likely addicts.” However, as we note, one effect of the separation of pharmaceutical dependence from ordinary addiction is that harm reduction measures are not presented as relevant to this form of drug use.

Finally, we have explored representations of pharmaceutical dependence through the notion of iatrogenesis. Poor medical care and the failings of an inadequate health system are key elements of the construction of this problem, reinforcing the blamelessness of sufferers. In addition, increased regulation of doctors via prescription monitoring is endorsed as an effective solution to the issue. In this sense, pharmaceutical dependence is constructed in the media as iatrogenic. However, in the media discourse, the critical perspective on medicine is limited, with a focus on individual negligence. In fact, the regulatory top-down systems which are positively framed as responses to the issue move decisions about care further away from consumers and arguably intensify medical power and control. Therefore in dominant framings of the problem of pharmaceutical dependence, media accounts reproduce both moral hierarchies of addiction and the naturalization of medical authority.