Opioid manufacturers sell around $7-8 Billion worth of opioids every year. While most prescribing decisions are made by doctors based on solely on their professional expertise and a patient's medical need, there is a growing body of evidence that payments to doctors by opioid companies can significantly influence when and how they prescribe opioids to patients.
Thanks to the Physician Payments Sunshine Act, we can now see the amount and number of payments received by each physician from drug companies.
Between 2013 and 2015, opioid manufacturers paid over $46 Million to 68,177 physicians. 1/12 physicians received payments from these companies, including 1/5 family physicians. The largest payments covered speaking fees, however most were for food and beverages. On average, physicians received a median of $15 during that period from opioid manufacturers.
Who Did They Target?
Researchers found that not all Americans were targeted equally by opioid manufacturers. In order to see which Americans were targeted more frequently, researchers compared the concentration of physician payments and the characteristics of each county in America.
On average, for every 1000 Americans in a county, physicians in that county received $1.57 in payments from opioid manufacturers.
Counties that were mostly white or had high unemployment rates received more payments, at an average of $1.88 per 1000 residents and $1.97 per 1000 residents respectively.
Counties that were in cities or their surrounding suburbs received an average of $2.81 per 1000 residents.
The counties that received the most payments were in the Northeastern States, including New York and New England, which received an average of $3.54 per 1000 residents. These counties on average received over twice as much per capita as the average American county.
The Effect of Opioid Marketing on Prescription Rates
In order to see whether these payments had any effects on opioid prescriptions and overdoses, researchers compared the number of payments made to physicians in each county to the rates of opioid overdoses and opioid prescriptions 1 year later.
While this method does not prove causality, it can potentially provide evidence of strong links between payments and prescription rates.
Counties with the highest numbers of payments to physicians, as defined by counties in at least the highest 85th percentile of physician payments, had an approximate 13x increase in the number of opioid prescriptions relative to the average American county.
This suggests that payments to physicians are very effective in raising the amount of opioids prescribed.
The Effect of Opioid Marketing on Opioid Overdoses
The most important question here of course is whether payments to physicians increase opioid overdose rates. Most opioid prescriptions are for valid medical needs and should not be stigmatized.
However, an increase of opioid overdose deaths would signify that payments to physicians are indeed causing more inappropriate prescriptions.
Based on this data, researchers found in counties where physicians received the most payments, as defined by being 1 SD greater than the mean, residents had a 18% higher risk of opioid overdose mortality 1 year later.
These data show that when drug companies pay doctors, doctors are more inclined to prescribe these drugs, whether they know it or not. For most drugs, this becomes problematic as it potentially increases our healthcare spending.
However, for opioids, this is particularly problematic as it clearly plays a role in driving our opioid epidemic.