How Big Pharma's Payments To Doctors Affected Overdose Deaths

By Paul Gaita 01/22/19

A new study examined the link between large payments and gifts to doctors from pharma companies and overdose deaths.

a big pharma sales rep talking to a doctor

In counties and states where opioid manufacturers offered large payments or gifts to doctors to promote their product, a new study has suggested that both opioid prescriptions and opioid-related overdose deaths were higher than in other areas.

Coverage of the study in The New York Times showed that the study culled information from a variety of sources, including the Open Payments database, which tracks payments by pharmaceutical companies to doctors, and data from the Centers for Disease Control (CDC).

Information from these sources suggested that spending on physicians was most highly concentrated in the Northeastern United States, where certain cities and counties claim some of the highest overdose death rates in the country.

The study, conducted by researchers from Boston University School of Medicine, Boston Medical Center and New York University School of Medicine, and published in the Journal of the American Medical Association, filtered data from the aforementioned national databases through three criteria: total dollar value of marketing efforts by companies spent on doctors, number of payments and number of physicians that received any marketing. 

According to the researchers, the pharmaceutical industry spent approximately $40 million promoting their opioid products to nearly 68,000 doctors between 2013 and 2015. The marketing efforts included paid meals, trips and consulting fees.

By referencing overdose data and opioid prescription numbers from the CDC, they determined that for every three additional payments made to doctors per 100,000 people in a county, overdose deaths involving prescription opioids would rise 18% over a year's time.

Marketing to doctors dropped significantly in the period immediately following the years included in the study by 33%, which The New York Times attributed to public pressure on companies after the opioid epidemic began reaching critical levels.

Cities and counties in the Northeastern US that received some of the largest payments also had some of the highest overdose rates, including Salem and Fredericksburg in Virginia, Cabell County in West Virginia and Lackawanna County in Pennsylvania.

As The New York Times noted, the study authors also suggested that the number of interactions such as free meals appeared to be more strongly linked to overdose deaths than the amount spent on such interactions. 

"Each meal seems to be associated with more and more prescriptions," said study lead author Dr. Scott Hadland of Boston Medical Center's Grayken Center for Addiction. Hadland and his co-authors also wrote that the study did have limitations: They were unable to differentiate between overdose deaths involving prescribed opioids and those caused by painkillers obtained through illegal means.

"We acknowledge that our work describes only one part of the very complex opioid overdose crisis in this country," said Hadland. "Even still, prescription opioids remain involved in one-third of all opioid overdose deaths, and are commonly the first medications that people encounter before transitioning to heroin or fentanyl. It is critical that we take measures now to prevent marketing from unnecessarily exposing new people to opioids they may not need."

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Paul Gaita lives in Los Angeles. He has contributed to the Los Angeles Times, Variety, LA Weekly, and The Los Angeles Beat, among many other publications and websites.