Pharma Marketing Directly Increased Opioid Mortality

Pharma Marketing Directly Increased Opioid Mortality

New study of cash inducements paid to physicians adds increased opioid-
related deaths to the already proven outcome of increased prescribing

There's been a lot of speculation in the media and at all levels of government about the role possibly played by pharmaceutical companies in helping foster the opioid crisis and its appalling number of opioid-related deaths.

Now a landmark study from Boston Medical Center, published in JAMA Network Open, has analyzed relevant data in more than 2000 U.S. counties, and come up with an answer.

What has emerged is a direct, clear and undeniable relationship between pharma direct marketing to physicians, their subsequent prescribing patterns, and opioid-related overdose fatalities.

(By "direct marketing to physicians" we mean actual cash and other inducements paid directly to doctors to encourage prescription writing of the company's products - in this case, opioid painkillers.)

An earlier study by the same researchers published last August found conclusively that direct marketing to doctors in 2014 resulted in nearly 10 percent more opioid prescriptions the following year. That study pointed fingers at doctors as the culprits for the prescription opioid epidemic.

Now we have pharmaceutical industry cash inducement as a precursor to increased physician prescribing, the resulting epidemic, and finally, the big one: opioid-related fatalities.

Nearly $40 million handed out

The Boston Med researchers, led by Scott E. Hadland, MD, MPH, conducted a population-based, cross-sectional study across 2,208 US counties, covering the period from August 1, 2013 through December 31, 2015 for both studies.

They learned that in the counties studied, there were 434,754 payments totaling $39.7 million invested by pharmaceutical companies marketing directly to 67,507 physicians in those counties.

The new study weighed three marketing factors against the number of prescriptions written in a county and the subsequent number of opioid overdose deaths in that county:

a) The number of doctors per capita in a county receiving (any number of) payments

b) The total number of payments in a county

c) The total dollar amount of payments in a county.

Factor a) above, the number of doctors receiving payments, was the leader of the three factors in number of prescriptions written and subsequent opioid-related deaths.

Factor c), the total dollar amount spent, had the least association with prescribing patterns and overdose deaths.

"Per capita, the number of marketing interactions with physicians demonstrated a stronger association with mortality than the dollar value of marketing," the researchers said.

Again, "marketing interactions" is a nice way of saying "inappropriate incentives."

State lawsuits against pharma

According to an article in MedPage Today, some states are already introducing penalties for marketing opioids directly to doctors.

For example, Boris Tabakoff, PhD, a pharmacologist at University of Colorado, told MedPage Today that the state of New Jersey has "set limits on the number of manufacturer gifts and payments that can be given to prescribers. These individuals that go out are called detail men, and they should live up to their names. They should detail not only the benefits of the product that they're trying to have the physician prescribe but also the side effects and dangers."

Meanwhile, a major lawsuit against Purdue Pharmaceuticals, the first truly aggressive opioid marketer, was recently filed by Massachusetts, detailing harmful direct opioid marketing. Massachusetts' suit against Purdue follows similar suits by nearly 30 other states, many of which also name other pharma companies, distributors and even some retailers.

Starting back in the 1990s, Purdue set out to create a favorable climate for its opioid painkiller OxyContin. The company worked hard to influence med schools to increase OxyContin prescribing and create more positive attitudes toward opioid painkillers among med students. For example, the company contracted with another pharmaceutical company with a larger sales force to help blanket the U.S. with sales reps for direct physician marketing. And in West Virginia, rebate strategies were set up with pharmacy benefit managers to ensure continued "favorable treatment" for OxyContin, in spite of legislative or other efforts to stop it.

The Massachusetts suit alleges that Purdue set up "tight relationships" with major med schools in the state to combat negative reports about opioid addiction and to generate goodwill toward opioid painkillers among med students.

Dinners and lunches?

According to MedPage Today, Boston Medical's Hadland said that another factor is also in play that is costing pharma less than cash payments to doctors, but contributing even more to opioid-related deaths.

"A lot of national attention has been paid to drug companies paying large amounts of money to doctors to promote their product," Hadland said. "What's actually much more widespread, legal, and occurring practically all across the U.S. is much lower cost meals that drug companies offer to doctors. That actually seems to be the more important factor of prescribing and potential overdose deaths."

There's no specific data in the study identifying the opioids involved in deaths, but it's assumed that many deaths involve drug interactions. Also, opioid prescribing has decreased since 2010, but rates still range three times higher than 1999, the study said.

"Increased county-level opioid marketing was associated with elevated overdose mortality one year later, an association mediated by opioid prescribing rates," the study authors said. "The potential role of pharmaceutical industry marketing in contributing to opioid prescribing and mortality from overdoses merits ongoing examination."

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