President Donald Trump is promising a "massive advertising campaign" as part of his administration's response to the worst drug crisis in U.S. history, but past marketing efforts have shown few results and experts say other measures could be more effective in curbing the current epidemic.
Trump declared opioid overdoses a public health emergency on Thursday and laid out steps to combat addiction and abuse with heroin and prescription painkillers, drugs that kill nearly 100 Americans daily.
Trump put special emphasis on advertising to discourage young people from trying drugs, saying, "They will see the devastation and the ruination it causes."
"I think that's going to end up being our most important thing," Trump said in a speech from the White House. "Really tough, really big, really great advertising, so we get to people before they start."
Yet government and academic assessments of "Just Say No"-style messages have repeatedly shown poor results.
Between 1998 and 2004 the U.S. government spent nearly $1 billion on a national campaign designed to discourage use of illegal drugs among young people, particularly marijuana.
A 2008 follow-up study funded by the National Institutes of Health found the campaign "had no favorable effects on youths' behavior" and may have actually prompted some to experiment with drugs, an unintended "boomerang" effect.
Experts say the key to successful campaigns are approaches that produce changes in behavior, not just an emotional reaction. Above all, avoid scare tactics.
"Substance abuse is much more complicated than a simple choice of yes or no," said Lori Criss, chief executive officer of the Ohio Council of Behavioral Health & Family Services Providers.
More recently, anti-drug promotions have shifted their focus, appealing to teenagers' desire for independence and self-control rather than fears about drug use. A 2011 study of the government's "Above the Influence" campaign suggested eighth-graders who had seen the messages were less likely to have tried marijuana than those who had not.
Older drug prevention campaigns from the 1980s and 1990s have fared poorly under scientific review.
A 2009 analysis of 20 studies of school-based D.A.R.E. programs showed students who underwent training were about as likely to try drugs as those who didn't. The program, founded in the early 1980s, sent local police officers into thousands of U.S. schools to warn about the dangers of drug use.
"The evidence is clear that the D.A.R.E. programs, fear-based advertising, and Just Say No campaigns of the 1980s had no benefits at all," said Keith Humphreys, a psychiatrist at Stanford University who served as a drug policy adviser under President Barack Obama.
Humphreys pointed to community-based outreach programs as a more effective way to influence high-risk behavior in school children.
A 2014 study of one program, Communities that Care, showed that students enrolled in the program in fifth grade were more likely to abstain from drugs, tobacco and alcohol as 12th-graders.
Several other notable statements from Trump's speech are confirmed by government data:
— "An astonishing 90 percent of the heroin in America comes from south of the border," Trump said.
Heroin from Mexico accounted for 93 percent of the heroin seized and analyzed by the Drug Enforcement Administration in 2015, according to latest figures from the agency. The remaining 6 percent came from South America or Asia. The agency can determine the source of heroin through chemical testing.
— "Drug overdoses are now the leading cause of unintentional death in the United States by far. More people are dying from drug overdoses today than from gun homicides and motor vehicles combined," Trump said.
Approximately 64,000 Americans died from drug overdoses in the past year, most involving legal and illegal opioids, according to data from the Centers for Disease Control and Prevention. That's higher than the roughly 49,000 combined deaths due to gun homicides and car crashes, which killed about 13,000 and 36,000 Americans in 2015, respectively, according to the latest federal figures. The CDC tracks the leading causes of death nationally.
Associated Press writer Andrew Welsh-Huggins contributed to this report.