It has been an annoying week at the opioid news. Some days ago, New York Times reported on legal documents that revealed how the Sackler family, which owns the company that produces OxyContin, pushed doctors to prescribe more and more dangerous opioids, "urged sales representatives to advise doctors. To prescribe the highest dose of the powerful opioid analgesic because it was the most profitable. "Today, a study published in the JAMA Network Open reveals exactly how this kind of pressure works ̵
As New York Times reported that the study found that "for every three additional payments made by companies to doctors per 100,000 people in a county, overdose was fatal. with prescription opioids that one year later 18 percent higher. " Over two years, the study said, "$ 39.7 million in opioid marketing was targeted at 67507 doctors across 2208 US counties" with 434,754 total payments made. One of the counties with high levels of medical payments and opioid deaths was Cabell County, West Virginia, which Times said "one of the highest overdose rates of death in the nation," although its overdose totals fell 40 percent in 2018, according to Herald-Dispatch . Nevertheless, the 95,000-person county saw "an average of three emergency calls a day" for overdoses, the paper reported.
The information on these payments comes from the Open Payments database and includes things like "meals, travel expenses, voice rates, fees, advisory fees, or educational costs." These types of payments are common in the medical business (and unfortunately, a business): A study from 2017 showed that about half of the doctors received payments from pharmaceutical companies. And these companies spend more on marketing than they do on research and development, despite the critics' claims that Medicare for everyone would kill pharmaceutical "innovation."
These payments, as you would expect, affect prescription habits, which means doctors can end up prescribing a drug that is not best for their patient or it costs more than an equally effective alternative. A minor scale study from the Boston Medical Center's Grayken Center for Addiction in March 2018 showed that doctors receiving meals from pharma companies prescribed 9 percent more opioids. Another study showed that meals with a Pfizer rep increased the reception for their two cholesterol drugs, Lipitor and Crestor, by 73 percent. Another study found up to 2016 that doctors were "up to twice as likely to prescribe the promoted branded products as doctors who did not receive meals." Labeling is much more expensive than generic drugs – and these drugs are how big pharma makes its huge profit.
Meanwhile, a JAMA study found that one in five adolescents who died in 2016 died from an opioid overdose, and the National Security Council said this week that the odds of dying from an opioid overdose are now higher than the probability of dying in a traffic accident.
Times noted that both opioid preparations and payments to doctors are falling, thanks in part to more public control of the actions of these companies. And it is important to remember that 80 percent of opioid users had not prescribed the drug themselves, instead of getting them from others – but often from those with prescriptions.
The study is an indictment for America's ill health system more widely. It is appalling to think that these companies, with billions on sale each year, spend millions pushing doctors to prescribe dangerous substances. And it is appalling to think about the attitude that this practice generally puts patients in: Not knowing if their doctor only thinks about what is best for them medical or who bought them their last steak dinner. There is no need to allow drug disbursements to doctors to continue, and today's study clarifies: banning these payments could save lives.