BACKGROUND: Industry-funded patient advocacy shaped opioid-related public health messaging, yet less is known about how such advocacy constructed opioid access for military veterans, a population with high moral standing and pain burden. Astroturf activism refers to sponsor-supported advocacy presented as independent grassroots or patient-centered mobilization, thereby obscuring or backgrounding commercial interests. This study contributes to scholarship on the commercial determinants of health by examining how industry-supported advocacy mobilized veteran identity, deservingness, and pain-related rights claims.
PURPOSE: We examine how the American Pain Foundation’s Military/Veteran Initiative represented veterans’ pain, opioid access, addiction risk, clinical caution, and patient advocacy in public, industry-linked materials. METHODS: We conducted a triangulated qualitative case study using litigation-derived documents from the Opioid Industry Documents Archive, archived Military/Veteran Initiative online materials, and a key-informant interview with the writer commissioned to write Exit Wounds, the initiative’s key publication.
RESULTS: Two mechanisms emerged. First, rights-based framing positioned long-term opioid therapy as care wounded service members had earned through military service. Second, proxy-voice credibility used veteran-centered narrative to give moral authority to opioid-favorable clinical claims. Exit Wounds translated industry-aligned pain messaging into the voice of a sympathetic veteran advocate, while minimizing addiction risk and reframing clinical caution as stigma, inadequate education, or “opiophobia.”
CONCLUSIONS: This case shows how industry-supported advocacy can convert product-favorable messaging into patient-centered moral claims. Findings support independent conflict review of patient-facing education distributed through health systems, advocacy organizations, and public agencies.
Astroturf activism and opioid advocacy targeting veterans: A qualitative case study of the American Pain Foundation’s Military/Veteran Initiative
SSM - Qualitative Research in Health, 10, 100877. doi: 10.1016/j.ssmqr.2026.100877.