Abstract/Project Summary
Understanding the role of the pharmaceutical industry in propelling the current opioid crisis in the U.S. is an
essential strategy for preventing future epidemics. Using multiple forms of textual data and innovative
methodologies for data mining and triangulation, this project examines the specific impacts of industry efforts to
target military veterans as opioid consumers and analyzes how new industry-driven narratives, or scripts,
about opioid analgesics were circulated. Veterans have many vulnerabilities and are one of the populations
most severely impacted by the opioid crisis and opioid-related harms, including overdose and HIV/HCV
infection. Important documents emerging in litigation against pharmaceutical companies establish that
veterans were targeted as an important consumer niche through advocacy groups and paid accounts from
veterans about the benefits of opioid therapies. However, only a small portion of the documents currently being
revealed in the process of legal discovery have been examined by public health researchers, and very little is
currently known about broader industry agendas and the processes by which pro-pharma narratives became
part of veteran-specific health discourse, driving attitudes toward opioids and raising barriers to non-opioid pain
management. To identify the themes and elucidate the processes by which these scripts were internalized by
different veteran populations, this mixed-method research will triangulate large datasets of pharmaceutical
industry marketing and legal documentation with veteran-themed publications and the lived experience of
chronic pain patients. Findings will be translated into deliverables which positively impact pain management
policy, practice, and the attitudes and expectations of veterans with chronic pain. The scientific team includes
veterans and scientists at the forefront of uncovering how the tobacco industry targeted military personnel and
veterans, along with experts on opioid use and pharmaceutical industry litigation. The systematic textual and
content analyses in this study represent a critical case study in pharmaceutical industry efforts to change
prescribing policy and popular culture and will serve as an important contribution to literature on the natural
history of drug crises and to clinical approaches to pain by achieving the following aims:
Aim 1: Use textual mining technology and analytic methods refined by tobacco researchers to explicate the
pharmaceutical industry's campaign to influence veterans' (and veterans service organizations') perceptions
opioid therapies, particularly within the context of chronic pain management.
Aim 2: Conduct qualitative interviews among veterans with histories of pain and opioid use to understand
sociocultural meanings and cognitive scripts that impede safe, effective, and medically-appropriate care.
Aim 3: Based on a synthesis of data from Aims 1 and 2, conduct T0 and T1 translational research to generate
concrete best practices, tools, and web resources to guide clinical and prescriber engagement with veteran
and other chronic pain populations.