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.

Public Health Relevance Statement/Project Narrative 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 various forms of textual data and analytic methods, this project examines the specific impacts of industry efforts to target military veterans as opioid consumers and the ways that the industry attempts to popularize new narratives, or scripts, about opioid analgesics within veteran-specific periodicals. The identification of dominant narratives and their circulation through veterans' media outlets represents a critical case study in pharmaceutical industry efforts to change prescribing policy and popular culture. Findings will be translated into deliverables which positively impact pain management policy, practice, and the attitudes and expectations of our nation's veterans and others struggling with chronic pain.