Opioid deaths linked to drug marketing to physicians, study
A new study suggests hospitals and regulators should do more to limit drugmakers' marketing interactions with physicians, after finding a link between marketing and high prescribing rates and overdose deaths in those areas.
For every three additional payments made to physicians per 100,000 people in a county, opioid overdose deaths increased by 18%, according to findings published Friday in JAMA Network Open.
The payments most often came through meals, travel costs and speaking and consulting fees. All in all, physicians received $39 million from drugmakers between August 2013 and December 2015.
But the study suggested that the frequency of the marketing interactions rather than the individual payment amounts had a greater impact on physicians' opioid prescribing habits.
"The number of payments actually mattered more than the amount doctors were paid," said study co-author Dr. Magdalena Cerdá, a study co-author and director of the Center for Opioid Epidemiology and Policy at NYU School of Medicine. "We hypothesized that that's due to the fact that the more times you interact with pharmaceutical representatives, it can build more of a relationship of trust, and that can have a greater influence in the decisions that you make about what you prescribe."
Previous research has highlighted the financial relationship between doctors and the opioid drug makers. A 2017 study found one in 12 physicians had received payments from opioid manufacturers between 2013 and 2015, and the top 1% of physicians received an average of $2,600 each. But the average payment overall was $15.
The latest study is one of the first to link payments made to physicians with increases in prescribing and opioid overdose deaths.
"It's not in any way nefarious or intentional on the part of physicians," Cerdá said. "It's really likely an unintentional change given increased awareness of the products, increased trust of the companies because of these frequent interactions."
More than 70,000 people died from drug overdose in 2017, according to the Centers for Disease Control and Prevention. Among those deaths, nearly a quarter, or 17,029, involved prescription opioids. In a report released on Thursday, the CDC found that in 2017, 14 rural counties were among the 15 counties with the highest opioid prescribing rates.
Counties in Virginia, West Virginia, Pennsylvania and Ohio were among the areas that received the most payments per 1,000 people between 2013 and 2015, according to the study. West Virginia, Ohio and Pennsylvania in particular are some of the areas hardest hit by the opioid epidemic. They made up the top three highest rates of overdose deaths in 2017, according to the CDC.
The study noted the link between marketing and high opioid morality could be reverse causality, where drugmakers were targeting counties that were already experiencing high rates of opioid prescribing.
Cerdá said the findings indicate a need to limit the amount of interaction between opioid marketers and physicians.
"We need to pay attention to not only putting a cap on the total value of marketing but on the number of times doctor can interact with the pharmaceutical industry," Cerdá said.
She said health systems could opt to self-regulate by putting in place policies that prohibit physicians from accepting any payments or drug samples from the pharmaceutical industry. Many providers have implemented such policies.
Cerdá suggested state and federal governments could also put limits on the number of interactions opioid manufacturers are allowed to have with prescribers. Last January, a New Jersey rule went into effect that capped all direct payments pharmaceutical companies could make to physicians to a maximum of $10,000 a year, with $15 meal cap for all activities.
Dr. Ross McKinney, chief scientific officer for the Association of American Medical Colleges, said many of the country's academic medical centers have had policies in place for years that set limits on interactions between doctors and drug industry representatives. The organization in 2008 put out policy recommendations that urged academic medical centers to implement policies to prohibit acceptance of payments from drug companies and that limited on-site visits from representatives.
"There's been a pretty broad acceptance that there was too much access, too much gift giving, and it needed to be restrained," McKinney said.
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