Sunday's Super Bowl victory by the Denver Broncos over the Carolina Panthers was panned by many viewers as kind of sloppy and less than thrilling. But at least the commercials offered something to talk about — particularly two ads devoted to bowel movements.
One featured an anthropomorphic intestine hawking Xifaxan, an anti-diarrhea medication. The other, filmed in black and white, showed a handsome middle-aged man with "envy" — specifically, he envied the ability of other men, women, and animals to poop. The man looked dismayed as another guy smiled proudly after leaving a restaurant bathroom. He looked jealous when he spotted a dog pooping on a curb. He eyed a window display of prunes and gazed at a snail that was informing passersby about a condition known as opioid-induced constipation.
Both ads were the subject of derision on social media, with some suggesting that the protagonist of the constipation commercial should try eating Taco Bell to solve his problem. Others noted that it seemed odd for opioid-induced constipation to be featured in the lineup of pricey — 30 seconds of airtime cost up to $5 million this year — Super Bowl commercials.
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 quadrupled since 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.
'AstraZeneca came up with an extremely lucrative solution: A pill to solve the problem caused by other pills.'
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 reportedly directed 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.
When we need a super bowl ad for people with opioid induced constipation... It might be time to admit we have a problem.
— Aaron E. Carroll (@aaronecarroll)February 8, 2016
Intriguingly, the ad never mentioned the brand name Movantik — it simply told viewers to check out the website OICIsDifferent.com, which provides general information about opioid-induced constipation. The site has a link for users to "discover a prescription treatment option," which redirects to the Movantik website. This could have something to do with the stigma associated with opioid-induced constipation — 77 percent of the respondents in AstraZeneca's constipation survey last year agreed that it's a condition "people are ashamed or embarrassed to talk about."
The other possible explanation is that by not mentioning Movantik specifically, the ad skirted rules that require pharmaceutical companies to list all of the risks and side effects of the medication that's being sold. Half of the Super Bowl ad for Xifaxan, the anti-diarrhea drug, was devoted to explaining all of the unpleasant things that can happen to people who use it.
As Movantik's website explains, the drug commonly causes side effects that are very similar to opioid withdrawal, including abdominal pain, nausea, gas, vomiting, headache, excessive sweating, and excessive flatulence. Movantik also causes diarrhea, but, as anybody who watched the Super Bowl commercials is now aware, there's now a pill available to fix that too.
_Follow Keegan Hamilton on Twitter: _@keegan_hamilton