“Just Advil”: Harm reduction and identity construction in the consumption of over-the-counter medication for chronic pain

Abstract

Direct-to-consumer marketing has sparked ongoing debate concerning whether ads empower consumers to be agents of their own care or shift greater control to the pharmaceutical industry. Ads for over-the-counter (OTC) medications in particular portend to offer simple, harmless solutions for meeting the demands of social life. Rather than join the longstanding debate between consumer agency and social control in pharmaceutical advertising, I approach self-medication with over-the-counter (OTC) analgesics using Harm Reduction as a framework. From this perspective, consumption of OTC analgesics by chronic pain sufferers is a means of seeking some level of relief while also avoiding the stigma associated with prescription pain medication. Qualitative methods are used to analyze data from two sources: (1) semi-structured qualitative interviews with 95 participants in a trial examining the effectiveness of Traditional Chinese Medicine for Temporomandibular Disorders (TMD) from 2006 to 2011 in Tucson, AZ and Portland, OR; and (2) print, online, and television advertisements for three major brands of OTC pain medication. Participants described their use of OTC medications as minimal, responsible, and justified by the severity of their pain. OTC medication advertising, while ostensibly ambiguous and targeting all forms of pain, effectively lends support to the consumption of these medication as part of the self-projects of chronic pain sufferers, allowing them to reconcile conflicting demands for pain relief while being stoic and maintaining a positive moral identity. Describing OTC medication as “just over-the-counter” or “not real pain medication,” sufferers engage in ideological harm reduction, distinguishing themselves from “those people who like taking pain medication” while still seeking relief. Justifying one’s use of OTC medication as minimal and “normal,” regardless of intake, avoids association with the addictive potential of prescription pain medications and aligns the identity of the chronic pain sufferer with a culturally sanctioned identity as stoic bearer of pain.

Characteristics of medication advertisements found in US women’s fashion magazines

“…23 Prior studies have determined that unlike DTCA, OTCA has featured more content regarding the benefits of a particular products than the risk, omitting potentially dangerous health consequences, 24 an observation confirmed in our analysis. Overall, less information is presented through OTCA than DTCA, even though the targeted consumers are the final decision makers for purchasing these medications.…”

“…2 Few have hypothesized on the decision-making process of consumers, resulting in limited information on consumer attitudes advertisements and the overall impact of OTCA. 2,23 …”

Self-Medication With Over-the-Counter Analgesics: A Survey of Patient Characteristics and Concerns About Pain Medication

“…From this perspective, individuals with chronic pain might use OTC analgesics as a harm reduction strategy, by seeking some level of pain relief while also avoiding or reducing the potential harms associated with prescription pain medication. Such harm reduction strategy has been described previously by chronic pain sufferers in a qualitative interview study 10 . Participants of that qualitative study cited several reasons to avoid prescription pain medication, including: (a) maintaining awareness of pain to monitor symptoms and avoid further damage; (b) saving medication for when really needed; (c) perception of medication as less effective if taken often; (d) concern that pain medications impair ability to function normally; and (e) concern about addiction.…”

“…They regarded prescription pain medication as a poor coping strategy, as they know pain would return as soon as medication wore off. Instead, participants chose to use OTC pain medications, still with reluctance, to mitigate downside risks while still gaining some level of relief 10 . Such benefit/risk trade-offs are in line with the necessity-concerns framework that is currently prevailing in drug adherence research 11,14 .…”

Association between NSAID Exposure and Kidney Function Decline in Primary Care Patients

“…5 OTCs have perceived safety based on widespread availability and direct to consumer advertising. 10 Providing NSAID education to people at risk for and with CKD should be part of the Advancing American Kidney Health Initiative's awareness campaign. 11 Clinicians should also be educated, as they will face continued challenges balancing the risk of NSAIDs with alternative therapies, including opioid analgesics, in high risk populations.…”