Do Perks for Doctors Fuel Opioid Deaths?

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Photo by Lou Stejskal via Flickr

Free meals to doctors and other “subtle” marketing techniques of drug firms may have helped drive the high mortality rates associated with the nation’s opioid crisis

That was the conclusion of a recent study by a team of medical researchers, who found that the often little-noticed perks offered physicians by drug companies seeking to promote opioid painkillers are one reason for the high number of opioid prescriptions that have led in turn to more deaths.

Such perks have a greater influence on prescription rates than the multimillion-dollar marketing campaigns of so-called Big Pharma, and are not likely to be affected by current federal or state efforts to curb pharmaceutical marketing activities, including setting monetary caps on the amount of payments doctors can receive from drug companies, the researchers said.

The study, published this month in JAMA Network Open, the online edition of the Journal of the American Medical Association (JAMA), was the first to explore whether there was a relationship between the aggressive marketing tactics of drug companies, the high number of opioid prescriptions, and the national epidemic of drug overdose deaths.

The researchers looked at overdose deaths in over 2,200 U.S. counties where physicians had been the targets of “nonresearch-based opioid marketing” valued at nearly $40 million between 2013 and 2015, and found that the same counties had “subsequently experienced elevated mortality.”

The study made clear that the figures did not necessarily suggest a cause-and-effect relationship between aggressive marketing and drug deaths, but they said it underlined the importance of more stringent regulation on drug marketing.

“Our findings such that direct-to-physician opioid marketing may counter current national efforts to reduce the number of opioids prescribed, and that policymakers might consider limits on these activities,” wrote lead researcher Dr. Scott Hadland of Boston University.

Big Pharma is already in the target sights of lawsuits filed by states and native American tribes, who claim that the companies’ failure to inform physicians that opiate painkillers are dangerously addictive and should be prescribed with caution was a primary cause of an epidemic that has killed thousands of Americans.

But the latest finding amounts to a condemnation of the traditional techniques used by pharmaceutical companies to promote a wide variety of drugs—not just opioids.

Efforts by some state governments, such as New Jersey, to set a cap on the dollar value of payments individual physicians could receive from drug companies would not necessarily address the problem, the researchers said, noting that the number of promotional payments or the number of physicians receiving them was more significant than the actual amounts received.

“Because most marketing interactions with physicians involve meals that typically have a low monetary value, a high dollar cap would affect only a minority of prescribers who exceed this amount,” the study said.

“As evidence mounts that industry-sponsored meals contribute to increased prescribing, data suggest that the greatest influence of pharmaceutical companies may be subtle and widespread, manifested through payments of low monetary value occurring on a very large scale.”

In the JAMA study, some 67, 507 physicians received promotional perks, including meals, speaking fees, consulting fees and honoraria from the drug companies.

The study added more ammunition to claims that “pharmaceutical marketing, in combination with excessive, inappropriate prescribing by physicians, could be viewed as one of the root causes of the current opioid epidemic,” Jordan Trecki of the Drug Enforcement Administration said in a commentary accompanying the study.

And in a statement following the study’s publication, the Pharmaceutical Research and Manufacturers of America declared that pain-medication prescribers “should be educated about the fundamentals of acute and chronic pain management, the range of available treatment options and relevant benefits and risks,” reported the Washington Post.

The study noted, however, that overdose deaths from prescription opiates accounted for just 40 percent of all opioid deaths in the U.S., and the number is declining as a result of strict new federal rules governing opioid prescriptions.

“Today, opioid-related overdoses…increasingly involve heroin, illicitly manufactured fentanyl, and numerous other substances such as alcohol, benzodiazepines and cocaine,” the researchers wrote.

Backlash from Pain-Relief Advocates

At the same time, the focus on curbing opioid prescriptions and imprisoning medical providers charged with selling painkillers under the table has generated a backlash among some doctors and healthcare advocates who say it has reduced the quality of life, and in some cases endangered the health, of patients who depend on them to control chronic pain.

See: Are Pain Doctors Wrongly Taking the Blame for the Opioid Crisis?

Nevertheless, the researchers argued, even the federal crackdown on pain-care providers has been undermined by some of the drug company marketing techniques that prevail across the industry.

“Reducing the number of opioids prescribed is only one facet of a much-needed, multipronged public health effort to reduce opioid-related harm,” the study said. “Nonetheless, further clarifying the limits of drug companies’ influence on physician prescribing should be a critical component of preventing the current crisis from worsening.”

.Additional reading: Laws Restricting Opioid Care Undermine Efforts to Curb Epidemic

The complete JAMA study is available here.

One thought on “Do Perks for Doctors Fuel Opioid Deaths?

  1. As I have noted on The Crime Report (June 21, 2018), there is no relationship between rates of opioid prescribing by doctors versus rates of opioid related mortality. The contribution of medically prescribed opioid pain relievers to mortality rates is so small that it gets lost in the noise. Likewise, the statement “overdose deaths from prescription opiates accounted for just 40 percent of all opioid deaths in the U.S” is bogus. This is actually the number of deaths in which a prescription opioid may have been one among many contributing factors.

    Prescription opioids are almost never found alone in postmortem tox screens. They almost always appear with illegal street drugs and/or alcohol. Likewise, morphine is a by-product of heroin metabolism, driving up the numbers attributed (falsely) as prescription-related deaths.

    If we ran the analysis carefully and cross-checked cause of death data more thoroughly, we would likely discover that of all overdose-related deaths, most likely fewer than 5,000 were a consequence of just prescription drugs — and almost all of those were potentially preventable if physicians had properly treated their patients’ pain, anxiety and depression.

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