Drug company payments to doctors may influence not just how many opioid prescriptions they write but the overdose death toll in their communities, according to a new study released on Friday.
Aggressive marketing of prescription narcotics over the past 20 years has been widely blamed for the staggering death toll of the opioid epidemic. But there’s been scant research supporting that contention.
The new study, published in JAMA Network Open, shows that counties receiving such payments later experience higher death rates — even when researchers controlled for many other possible influences. The study did not prove a cause and effect relationship; the link between the two is an association.
The study also suggests, surprisingly, that consistent, trust-building visits — such as periodic lunches sponsored by drug sales reps — do more to promote prescribing of a company’s drugs than high-dollar payments to physicians.
“What seems to matter most wasn’t the amount of money doctors were paid, it was the number of times they were paid,” said Magdalena Cerdá, an associate professor of population health and director of the Center for Opioid Epidemiology and Policy at the NYU School of Medicine.
Michael Barnett, an assistant professor of health policy and management at the Harvard T.H. Chan School of Public Health, who has studied the role of physicians in the opioid epidemic, called the findings “deeply concerning for the raging (opioid) crisis that we’re all quite aware of.”
The annual number of prescriptions for painkillers such as oxycodone, hydrocodone and methadone has declined in recent years as physicians, states and public health authorities have responded to the opioid epidemic. Still, overdoses from those medications killed nearly 18,000 people in 2017, according to the Centers for Disease Control and Prevention, even as illicit fentanyl has become the main driver of the opioid crisis.
And prescription painkillers — rather than heroin or fentanyl — are often the first opioid that consumers are exposed to.
Previous research has linked drug company marketing to opioid prescribing, but the researchers said their study was the first to extend the comparison to overdose deaths.
The new study matched federal data on overdose deaths in every county from Aug. 1, 2014, to Dec. 31, 2016, with payments to doctors for meals, speaking, consulting and travel for the period of Aug. 1, 2013, to Dec. 31, 2015.
The one-year time lag was an attempt to ensure that the payments influenced prescribing, rather than high-prescribing physicians attracting bigger payments from drug companies. In March, Harvard researchers and CNN released an analysis that showed physicians who prescribed more opioids attracted more payments from drug companies.
Barnett said that regardless of how the payments work, they are influential. Known in the trade as “detailing,” these efforts do affect prescriber decision-making, he said.
“What it does is it creates an awareness … it’s going to be closer to the top of your mind. It’s just easier to reach for them,” Barnett said.
“Counties receiving such marketing subsequently experienced elevated mortality,” they wrote. “In addition, opioid prescribing rates were strongly associated with the burden of opioid marketing.”