Big Pharma's Marketing to Docs Helped Trigger Opioid Crisis: Study
FRIDAY, Jan. 18, 2019 (Pharmacist's Briefing) -- Aggressive direct marketing to doctors by pharmaceutical companies is tied to spurring the ongoing epidemic of opioid abuse in the United States, a new study claims.
A county-by-county analysis showed that opioid use increased in places where drug makers focused their marketing efforts, explained lead researcher Dr. Scott Hadland. He's a pediatrician and addiction researcher at Boston Medical Center's Grayken Center for Addiction.
"The counties that had the most opioid product marketing from pharmaceutical companies were the counties that subsequently one year later had more opioid prescribing and had more opioid overdose deaths," Hadland said.
Drug company spending didn't need to be lavish to have an effect on opioid prescribing, either.
Pharma companies gained as much influence buying a meal for a doctor while talking up their product as they did paying loads of cash to influential docs in the form of speaking or consultation fees, the researchers found.
Opioid OD deaths grew by 18 percent with every three additional marketing payments made to physicians per 100,000 people in a county, researchers said.
Lawsuits and investigations targeting opioid manufacturers like Purdue Pharma, the maker of OxyContin, tend to overlook the impact of less blatant marketing efforts, Hadland said.
On Wednesday, it was reported that court documents show that the family that owns Purdue Pharma directed attempts to play down the dangers of the opioid painkiller.
"The investigators have focused on these large-value payments where a small number of doctors will get tens of thousands of dollars to help promote an opioid product," Hadland said. But, "our data are suggesting that the bigger public health problem is actually a much more subtle practice."
According to Hadland, "The dollar value of these payments is less important than the number of these marketing interactions that take place. The widespread practice of taking doctors out to lunch or dinner to talk about opioid products is probably contributing more to the opioid crisis in the U.S. than these less common instances of docs receiving really large-value payments."
At these lunches and dinners, pharmaceutical salespeople sold doctors on the idea that pain is undertreated. Sales reps also downplayed opioids' risk for addiction and overdose, said Linda Richter, director of policy analysis and research for the Center on Addiction, in New York City.
"Policymakers and state health regulators should prohibit licensed health professionals from accepting any such payments or incentives from the industry," Richter said. "Although physicians might believe that industry marketing efforts have no impact on their prescribing choices, a large body of evidence proves otherwise."
But a group representing drug makers said pharmaceutical companies have a role to play in providing patients with pain relief while curbing addiction risks.
In fact, the U.S. Food and Drug Administration currently "requires that training be made available to all health care providers who are involved in the management of patients with pain," said Priscilla VanderVeer, deputy vice president of public affairs at PhRMA. Drug companies that make opioid painkillers help provide funding for this training, she said.
"Physicians and other prescribers need the appropriate training and tools to ensure they can meet their patients' legitimate medical needs while also reducing the potential for abuse and this training should be mandatory," VanderVeer said.
In the meantime, the U.S. opioid addiction crisis continues. Abuse of the drugs led to nearly 50,000 overdose deaths in 2017, according to the U.S. Centers for Disease Control and Prevention.
Americans now are more likely to die from an opioid overdose than from a car or motorcycle crash, a fall, drowning, or choking on food, concluded a report issued Tuesday by the National Safety Council.
Heroin and fentanyl today are much more commonly involved in U.S. overdose deaths than prescription opioids, Hadland noted.
"Having said that, prescription opioids are still involved in about one-third of opioid overdose deaths, and they're commonly the first opioids people encounter before they start having a problem with addiction," he said.
Under the Affordable Care Act, pharmaceutical companies are required to report their spending on drug marketing to the U.S. Centers for Medicare and Medicaid Services.
That data showed that pharma companies spent $39.7 million marketing opioid medications to 67,507 doctors across 2,208 counties in the United States between August 2013 and December 2015. There were 434,754 payments in all, running the gamut from picking up a meal tab to thousands of dollars in consulting fees.
Hadland and his colleagues compared those marketing dollars and payments against county-level data on opioid prescribing and deaths from opioid overdose maintained by the CDC.
Opioid prescribing rates and overdose deaths increased with the amount of money spent on marketing, the number of payments made, and the number of physicians who received payments, researchers found.
"What's clear from our analysis is all this marketing is tied to greater prescribing of opioids and, in turn, elevated deaths from prescription opioids," Hadland said.
The investigators also found that the number of marketing interactions with physicians -- the number of payments made -- was more strongly associated with overdose deaths than the total amount spent. But the study only found an association and did not prove that marketing efforts caused overdose deaths.
"We already know that one in 12 U.S. physicians received marketing for opioids, and this proportion was even higher for family physicians, among whom one in five received opioid marketing," Hadland said.
"Our findings suggest that direct-to-physician opioid marketing may run counter to national efforts to reduce overdose deaths, and that policymakers should consider limits on marketing as part of a robust, evidence-based response to the U.S. overdose crisis," he concluded.
The findings were published Jan. 18 in the journal JAMA Network Open.
The U.S. Centers for Disease Control and Prevention has more about the opioid epidemic.