By ED SILVERMAN @Pharmalot
As efforts intensify to blunt the ongoing opioid crisis, a new study finds that increased marketing of the addictive painkillers to physicians was associated with more prescribing and, subsequently, more deaths from overdose. Interestingly, industry influence over physicians was greater based on the number of interactions, not the amount of money paid for speaking or the value of freebies, such as meals.
Between August 2013 and December 2015, drug makers made nearly 435,000 payments totaling $39.7 million to 67,500 doctors in 2,200 counties across the U.S. The payments were for meals, travel costs, speaking and consulting, but not research. And the data showed that the more marketing directed at physicians in a given county, the higher the number of overdoses, regardless of the money spent.
Specifically, in a county of 100,000 people, three additional payments to physicians were linked to 18 percent more prescription opioid deaths, according to the study, which was published Friday in JAMA Network Open. And one author, Dr. Scott Hadland, a pediatrician and adolescent addiction specialist at Boston Medical Center, noted previous research found more than 9 of every 10 marketing interactions with a doctor was for a meal, indicating drug makers spent relatively little money to win their attention.
The latest findings “suggest what matters is not so much the high value of payments to a few doctors, but the low value of payments to many doctors, for such things as meals,” said Dr. Magdalena Cerda, an associate professor of population health at the NYU School of Medicine. “The number of interactions rather than the amount the doctors are paid” contribute to prescribing and deaths.
The study authors acknowledged their analysis — which used data from the federal government Open Payments database and data from the Centers for Disease Control and Prevention on opioid prescribing and mortality from overdoses — leads only to an association, not a direct causal link. In other words, this is a sophisticated effort to connect important dots. A notable limitation in the analysis, though, is that it could not distinguish overdose deaths involving painkillers that are prescribed and those obtained otherwise.
The analysis measured industry marketing in three ways: the total dollar value of payments received by doctors; the number of payments made by drug makers; and the number of physicians who received payments. The study found payments were concentrated in counties with more high school graduates, greater unemployment, lower poverty, higher median household income, and lower income inequality.
“This likely suggests there was a systematic targeting of certain counties,” said Cerda.
Moreover, this appears to be the first study that links opioid marketing to opioid overdose deaths. For these reasons, the results are likely to cast the pharmaceutical industry, which is already shouldering blame for the prescription drug opioid crisis, in a still harsher light. A growing number of cities, counties, and states have filed lawsuits accusing opioid makers of downplaying risks and encouraging inappropriate prescribing. A widely anticipated trial is scheduled for later this year.
Earlier this week, meanwhile, a lawsuit filed by the Massachusetts attorney general that, until recently, was redacted, alleged that Purdue Pharma blanketed the country with sales reps, influenced legislation, and provided generous funding to medical facilities and universities in order to tout OxyContin. One disclosure caused particular outrage: A member of the Sackler family that owns the company pushed a strategy to divert blame for addiction and overdoses on to people who became addicted.
While the researchers did not distinguish between marketing by specific companies, they did examine the data on a county-by-county basis across the U.S. And the numbers were sobering. Take Cabell County in West Virginia, where 6.6 industry payments were made for every 1,000 people from 2013 through 2015, and the opioid prescribing rate was 122 for every 100 people. Meanwhile, the overdose death rate for opioid prescriptions was 93 for every 100,000 people in 2016, the highest in the country.
“All this marketing may run counter to the efforts to reduce overdose deaths,” Hadland told us.
The upshot, he added, is that policymakers should consider limits on marketing.
[This story was updated to note a limitation of the study].